A new survey released by the Centers for Disease Control and Prevention pegged the percentage of obese adults in the United States during 2007 at 26 percent.  That number is down from 34 percent in 2006.

We’re getting skinnier!

Not so fast.

Heights and weights were self reported.

From the Associated Press article:

CDC officials believe the telephone survey of 350,000 adults offers conservative estimates of obesity rates, because it’s based on what respondents said about their height and weight. Men commonly overstate their height and women often lowball their weight, health experts say.

The CDC conducts a more reliable study in which researchers “actually weigh and measure” participants.  That is where the 34 percent number comes from—its much more indicative of actual obesity levels.

Another AP article reports that we can do something about our staggering obesity issues.  An analysis by the Trust for America’s Health and several public health groups says that if we spend $10 per person over five years we would have the capital necessary to fight obesity resulting in significant annual cost savings.

Here’s the math: $10 x 300,000,000 American population x 5 years = $15,000,000,000.

The end result: reduced obesity levels resulting in annual savings of $16,000,000,000.

Full disclosure: research has been conducted suggesting that treating obesity doesn’t save money.

Regardless, the point is that this is about making Americans healthier.

Some local programs have already been implemented.  Read the article for examples.

It is time for all hospitals to jump on board.  A public health focus will be better for all of us.

Principle #27: Our Own System realizes the role of health care in a community is to help people be healthy.  Most of the time that means caring for patients with medical conditions.  It can also be about promoting healthier lifestyles before they arrive for treatment resulting from unhealthful behaviors.  The hospital’s job is to do both.  Promoting healthful activity is the basis of community activitysm.

Some have scoffed at the idea of traveling to India or Thailand for medical care.  How about New Zealand for the same reason?  They speak English and have such American necessities as McDonalds and Starbucks.  Rumor is the scenery is beautiful, too.

Medtral is hoping that an experience similar to that found in the United States will be the reason American health care travelers choose New Zealand for their next hip replacement.  From The Washington Post: “The company says it can offer procedures at boutique hospitals with follow-up personal nursing care at a fraction of the cost of the same surgery in the United States.”

Only 30 North Americans have registered with the company in ten months of existance.  The article also says that cost comparisons are difficult because of the variability in pricing across the U.S.  Medtral is focusing on a market they estimate at 75 million uninsured and underinsured Americans.

Here is the most important point, however:

“If my insurance company will cover the major share of the cost of the procedure, then I’m inclined to have it done here in California, since my biggest concern is what if something goes wrong,” says Shaw, an eighth-grade teacher from Mountain View, Calif. “I really don’t want to have to travel back to New Zealand for the sole purpose of doctor visits. That’s a bit expensive on a teacher’s salary.” If his insurer balks at the U.S. expenses, he is ready to make the case for traveling to New Zealand.

It always comes back to what patients will have to spend out of pocket.  Cost savings must be equivalent to the extra effort required to receive care in New Zealand (or any other country, for that matter). Getting a knee replaced requires significant rehab time and a few follow-up visits.  Turns out those tasks are easier to accomplish when the services are provided a few miles from the home rather than around the world.

“Will my insurance cover it?” and “How much is it going to cost me?” have been, and will continue to be, more important questions than “Who is doing my procedure?” and “Where is my procedure being done?”

That doesn’t seem right.

The last month has brought news of plans for new hospitals including this one, this one, this one, this one, this one, and this one.  There are more to be sure.

Aging hospitals, demographic shifts, increasing use of technology, and the evolution of patient care have spawned the need for new buildings.

Another story of new hospital construction is particularly intriguing: “An expansion at the University of Iowa Hospitals and Clinics will result in an increase in patient costs, but officials said they don’t yet know how much.”

The case of need can be made quite easily.  Americans are consuming more health care than ever before.  Increased patient volumes are directly correlated with need for more space.

But lacking in many stories of plans for new hospital construction is the cost implications to the patient.  This at a time when the number of uninsured is high.  At a time when patients are being expected to share more equally in their health insurance costs.  At a time that heralds warnings of health care costs reaching the 20 percent mark of gross domestic product.

So at least University of Iowa officials are being honest.  State of the art health care in state of the art facilities is going to cost more.

From the article:

University Hospitals Chief Financial Officer Ken Fisher said there’s no way to tell how much patient costs will rise because the size of the project and how it will be financed have not been resolved.

Fisher said building now rather than later is a good move for the consumer. With construction costs increasing each year and favorable lending conditions, the project would be more expensive in the future.

New hospital construction is adding costs to the system.  The building boom is showing no signs of slowing.  PriceWaterhouseCoopers estimates health care costs will increase nearly 10 percent in both 2008 and 2009—and new hospital construction is partly to blame.

Is the new construction worth the surcharge added to the final bill?

It depends. Truthfully, the answer may not matter.

The American Medical Association has been nothing short of controversial throughout its history.  The group has long taken conservative stances on policy issues in American health care.  Michael Moore’s Sicko portrays the AMA as a clear opponent to past universal health insurance movements in this country.  Wikipedia notes “Profession and monopoly, a book published in 1975 is critical of the AMA for limiting the supply of physicians and inflating the cost of medical care in the United States.”

Nonetheless the group has been the representative of physician interests over the years.  Its recent work to repeal a large reduction in physician Medicare reimbursements has been successful in the House and Senate.  The AMA has also been an active voice on public health issues as well as an advocate for reducing disparities in health care delivery.

However, AMA membership numbers are relatively low for a group that represents the interests of all physicians.  Surely the rise of specialty societies may be partly to blame.  According to a MedPage Today article only 244,005 of more than 900,000 physicians were members of the AMA in 2005.  The article estimates that only 135,300 of those members were actively practicing medicine.

Another reason may be, as Michael Ostrovsky points out in a question to AMA President-elect Dr. J. James Rohack, “discontent among doctors” with the organization.  Are low membership numbers an indication of the AMA losing its relevance in American medicine?

That’s a difficult indictment to make.

But it is worth noting recent activity by the AMA that could be construed as efforts to regain some of the relevance it may have lost over the previous decade.

The AMA has long been an opponent of publicly-funded health care.  In this election year it seems the group has reversed course a bit.  As the estimated number of uninsured Americans nears 50 million, the organization has launched its Voice for the Uninsured campaign.  Their proposal is to give all Americans the ability to purchase health insurance individually made available through market reforms.  While still not completly publicly-funded, the propospal does provide some public assistance through tax credits.  Here is the complete proposal.

Last week the AMA released on its website an apology to black physicians.  “The American Medical Association today apologizes for its past history of racial inequality toward African-American physicians, and shares its current efforts to increase the ranks of minority physicians and their participation in the AMA.”  An Associated Press article states that fewer than 2 percent of AMA members are black.  No wonder:

It wasn’t until the 1960s that AMA delegates took a strong stance against policies dating to the 1800s that barred blacks from some state and local medical societies.

Until then, AMA delegates had resisted pleas to speak out forcefully against discrimination or to condemn the smaller medical groups, which historically have had a big role in shaping AMA policy.

Better late than never.

These efforts may be the AMA trying to regain its relevance with physicians—especially with young doctors.  Then again these moves could also be political shuffling.  Traditionally conservative viewpoints are not the most popular political positions at the moment.  Is it a coincidence that the AMA has proposed a politically feasible (on both sides) health insurance policy as an election approaches that very well could end with Democrats ruling the House, Senate, and Oval Office?  Is it a coincidence that they apologized to black physicians for more than a century of exclusive policies (in 2008!!) as this country is in the midst of a very real opportunity to elect its first ever black President?

I hope so.

Ponder this: could our education system be responsible for our breaking health care system?  Could a flat ignorance of creativity be part of the reason we can’t seem to make necessary changes to embrace sustainable health care?  Increasingly the answer is looking like yes.

Dan Pink posted his commencement speech at the Minneapolis College of Art and Design on his Johnny Bunko website.

The entire speech is worth watching (and the Bunko book worth purchasing), but I’ll extract a quote here for use in relating to health care:

“The abilities that now matter most in a very, very hard headed way are really the right brain ones.  Artistry. Empathy. Inventiveness. Big picture thinking.”

Part One:

Part Two:

Sir Ken Robinson proposed the question, “Do schools kill creativity?” at Ted 2006.  His ideas inspire a new approach to education.  He says that creativity is as important in education as literacy.

“I have a big interest in education, I think we all do.  We have a huge vested interest in it.  Partly because it’s education that’s meant to take us into this future we can’t grasp.  If you think of it, children starting school this year will be retiring in 2065.  Nobody has a clue, despite all the expertise that has been on parade for the past four days, what the world will look like in five years time and yet we’re meant to be educating for it.”

The creativity necessary to fix health care in this country is increasing with each passing day.  While the major problems we are trying to solve will likely remain the same in root cause, the iteration of those issues will be very different.  Preparing students for the problems of tomorrow is a challenge—it is difficult to foretell what those problems will look like.  That’s where creativity comes in: we must not strip students of their creative abilities.  In fact, we must nurture them.

We live in a problem-solving society.  I’ve no doubt that we’ll get to where we need to get at some point.  However, improving our educational focus on creativity (at all levels) would expedite the process.

The solution just may be of the grassroots variety.  Read this post.  Jen and Ted and Berci think medical education needs some re-engineering.  As Jen writes:

If we’re working towards a more consumer-centric, patient-directed system, the educational component of such a revision must not be neglected.

And med students desperately need this kind of information and training included in curricula, NOW. As in next semester. As in 2 months from TODAY.

Not 3 years from now after lengthy Board meetings, celebratory approval, news releases, additional tenure-track positions secured and outside consulting agencies engaged.

This group’s creative thinking is moving the agenda forward.  Thankfully.  We just need more of it.

Comedy can sometimes be the best approach to making a point (if consistent f-bombs are not appropriate for your current viewing situation, come back later):

Found the video at Presentation Zen, for some great advice from Garr Reynolds on presenting, go here.

1. Why being able to log-on to Google after a patient leaves the Emergency Department is desirable.  An interesting statistic would be the number of return visitors for the same diagnosis because of poor communication/lack of understanding.

2. Recession proof? A story about layoffs (non-patient care variety).  Probably one of many in coming months.

Ben Casnocha wrote last week on a conversation he had with a friend who works for an NCAA Division I baseball program.  As Ben writes, “a lot of the staffers [baseball team] sign off emails with “AOEP” which stands for Attack on Every Pitch.”

He explains:

It’s a pitcher’s mantra. It doesn’t mean the pitcher has to throw strikes every pitch — a pitcher can still attack a hitter’s weakness by throwing out of the zone. It simply means that each pitch should have a purpose.

Recent posts on this blog have discussed frustrating bureaucracy and strategies to bust through it.

In bureaucratic non-profit organizations some activities can become part of the “way it’s always been done” mantra.  Phrases like “my boss told me to” become part of the everyday lexicon.  Activities can become wasteful.

Purpose is a powerful word.  Purpose can become a powerful activity.  In performing a job function, if you can’t answer the simple question, “what’s the purpose of this?,” there is a problem.  Speak up if you report to someone.  Listen if you’re reported to.  And end the purposelessness when necessary.

It’s a part of the Attack on Every Pitch philosophy.  Have a purpose.  Know the purpose.  Apply the purpose.

Principle #26: Too much waste.  Too many barriers.  Too much dissatisfaction.  Start breaking through by attacking on every pitch.

I don’t know if a single payer health care system would have prevented our current obesity situation—but it’s difficult not to look at our neighbors to the north and notice significantly lower levels of obesity on this map (via Richard Florida).

David Eaves:

If Canadian provinces were ranked along side US States, they would rank 1st (BC), 2nd (QC), 3rd (ON), 4th (AL) and tied for 5th (MB) (YK) as the least obese provinces/states. Colorado would be the first American state placing 7th, with the provinces of NS in 8th and SK in 9th.

Whatever the reason, Canada is doing something right, and the U.S. is going about the obesity situation all wrong.

Are generational differences in the workplace becoming a problem?

Steve Baker (writer at Business Week) at Blogspotting posted responses to such a question.  It’s an interesting thought worth further exploration.  Very interesting thoughts from the Twittersphere.

The tweets uncovered a gem of a story, too.  A gem that could provide a model for health care delivery innovation exploration.

Nick Eaton and seven of his young colleagues at the Spokane Spokesman-Review have been given the task by their editor (Steve) to “reinvent how a newspaper functions.”

We are charged to take a blank sheet of paper and come up with a way to make the Spokesman newsroom efficient while completing all if its objectives. The eight of us are meeting every day, often for several hours at a time, to work through this process.

A few guidelines and limitations have been laid out, but their remarkable task is fundamentally unpolluted.

Here’s the gist:

Our goal, as I understand it, is to come to Steve with a report by 5 p.m. July 10. He may or may not eventually implement our recommendations (we can have many), but he has promised to take them seriously.

Lots of work.  Lots of ideas I’m sure.  Very, very intriguing approach.

Interesting dialog:

There is skepticism and fear in the newsroom, of course. Many veteran Spokesman employees don’t like that Steve has selected eight young journalists and put some responsibility of the future of the newspaper into our hands. We don’t have the experience, they say. Steve sees it the opposite: We don’t have a stake in how newspapers have operated for 150 years, we don’t have a stake in who is in what editor position, we don’t really even have a stake in how the newsroom is currently structured.

Could a similar approach be used in health care?  Yes.  Could it be useful and productive and spark needed delivery innovation?  Yes.  It seems a perfect model for a hospital innovation center.