Friday, June 30, 2017

What happens when we don't see health as a common endeavor?

How much you believe in a need for universal health care is largely dependent on how much you see health as a common endeavor. The national policy debate we've been having lately and the health economics class I just completed have me giving it some thought.

Respecting people's preferences is an important tenet of economics. So, if you like to spend your leisure time watching football, smoking, drinking beer and eating pizza; we can presume that you know best what makes you happy and you alone suffer the consequences. If however, other people pay the price for your choices, then there is a social cost, and it is reasonable to consider some intervention.

Wednesday, June 21, 2017

Three Things We Should All Know About the Opioid Crisis

I attended the Vox Unconference, the World Heath Care Congress and a pharmacy summit this spring. There was one topic that overlapped the three events--the opioid crisis. It's all over the news, but so frightening, I think it bears mentioning here. Here are some things you need to know--especially if you're a parent.
  1. The risk of continued opioid use increases after 4 to 5 days. If there is a history of addiction in your family, even that amount of time may not be worth the risk.
  2. Opioids are not effective for treating chronic pain. They may work for a month or so, but the effect is likely to diminish even at increased dosages. Eventually, you'll be left with your chronic pain and a drug dependency. Some people even experience hyperalgesia, a greater sensitivity to pain after taking narcotics for longer periods of time.
  3. How pain came to be the fifth vital sign. The New Yorker ran through a good history in Who is Responsible for the Pain-Pill Epidemic. Vox reported, "US doctors wanted to treat pain as a serious medical problem. But when pharmaceutical companies pushed opioid painkillers with a misleading marketing campaign, they started a drug crisis."
Vox did a really great story on the crisis: How the opioid epidemic became America’s worst drug crisis ever, in 15 maps and charts. Please take a few minutes to scroll through it and watch the 4 minute video.

Tuesday, June 20, 2017

The Health Benefits of Being In the Presence of Trees

As I write, I'm sitting under
our silver maple tree.
Tree At My Window by Robert Frost 
Tree at my window, window tree,
My sash is lowered when night comes on;
But let there never be curtain drawn
Between you and me.
Vague dream-head lifted out of the ground,
And thing next most diffuse to cloud,
Not all your light tongues talking aloud
Could be profound.
But tree, I have seen you taken and tossed,
And if you have seen me when I slept,
You have seen me when I was taken and swept
And all but lost.
That day she put our heads together,
Fate had her imagination about her,
Your head so much concerned with outer,
Mine with inner, weather.
We sleep with the curtains open because I like to fall asleep looking at our silver maple tree. I figured Robert Frost would approve, but there may be more to my peculiar trait. Simply being in the presence of trees reduces the stress hormone cortisol and increases your immune defense system. It's part of a national health program in Japan where they call it "forest bathing." You can get the gist of it in this short video from the World Economic Forum. 

I don't need any convincing, but I'm still adding Your Brain on Nature to my reading list. This is yet another good example of where wellness and environmental issues intersect and it presents a unique opportunity for me to include a poem on my blog. 

Thursday, June 15, 2017

Life vs Disability Insurance -- Why are we far less likely to protect ourselves against the more likely event?

42 out of 100 ASHA staff are worried enough about protecting their families to buy life insurance, but only 25 in 100 had individual disability income insurance. These coverage choices don't reflect the actual risk. We undertook an initiative to offer supplemental disability (aka individual disability income) insurance to all our staff that had not taken it at the time they were hired. Now 53 out of 100 have individual disability income insurance. This initiative more than doubled the number of people with coverage. 

People are far more likely to become disabled during their working years than to die. You hear all kinds of numbers thrown around. I looked at disability and death probability tables published by the Social Security Administration for insured workers born in 1996. Death is pretty indisputable, but disability is more subjective. The Social security Administrations standard of disability is high, so this gives us a conservative estimate of disability.
  • Males born in 1996 (so they attained the age of 20 in 2016) have a 26.3% probability of disability before age 65 and a 7.2% probability of death.
  • Females born in 1996 (so they attained the age of 20 2016) have a 24.8% probability of disability before age 65 adn a 3.6% probability of death.
You can calculate your personal likelihood of disability using this tool from the Council of Disability Awareness.  

Sunday, June 11, 2017

Trump Administration Is Proposing a Giant Step Backward for Women's Health

Ian and I at a pro-choice rally
April 5, 1992
Half of pregnancies in the United States are unplanned. Maternal mortality is rising and much higher in the U.S. than in comparable countries like Canada and the United Kingdom. Maternity care and childbirth cost more in the U.S. than in the rest of the developed world. Yet, we are still debating whether or not health insurance should cover birth control and maternity care.

The Trump administration recently announced plans to roll back an ACA provision requiring insurers to cover birth control and the American Health Care Act would allow states to opt out of covering maternity care. Prior to the ACA, only nine states required maternity coverage and only 12 percent of plans available in the individual market place included benefits for maternity care. [Statistics from: How Obamacare changed maternity coverage.] Similarly, the Kaiser Family Foundation reported three in four non-group health plans did not cover delivery and inpatient maternity care in 2013, before the ACA was enacted.