Categories

Are We Health Engaged Yet? Frost & Sullivan Responds “Meh”

The top health-related activities among U.S. adults include routinely taking vitamins and supplements, and prescription medicines, according to Frost & Sullivan’s report, Are We Engaged Yet? Their response to the titular question lies in in the subtitle: “US consumers appear confused or ambivalent about what it means to be proactive or engaged in their health.” 1 in 2 U.S. adults says they’re “somewhat engaged” in their healthcare, according to Reenita Das’s write-up on the study in Forbes magazine. She notes that: Consumers with higher incomes have more confidence in their access to health care services and quality of care Budget-constrained consumer

Comments(0)

What Health Care Can Learn from the Blood Clot Community

  “Our goal is to create an aware and engaged, irritating set of patients who create a dialogue with health care providers once they’ve had a [blood] clot,” explained Randy Fenninger, CEO of the National Blood Clot Alliance (NBCA). NBCA’s tagline and hashtag is “Stop the Clot.” Welcome to the multi-stakeholder community involved with deep vein thrombosis (DVT) and, clinically speaking, Venous Thromboembolism (VTE). We’re talking blood clots, and the public health burden of this condition is big: it’s a leading cause of death and disability. One in 4 people in the world die of conditions caused by thrombosis. I had

Comments(0)

GoHealthEvents, An Online Source For Consumer Retail Health Opportunities

“Health comes to your local store,” explains the recently-launched portal, GoHealthEvents. This site is a one-stop shop for health consumers who are seeking health screenings and consults in local retail channels like big box stores, club stores, drug stores, and grocery stores. Events covered include cholesterol, diabetes, heart health, nutrition, osteoporosis, senior health, vaccinations and immunizations. By simply submitting a zip code, a health consumer seeking these kinds of services can identify where and when a local retailer will provide it. I searched on my own zip code in suburban Philadelphia, and found the following opportunities taking place in the

Comments(0)

Wearable Activity Tracking Device Purchasing Expected to Grow 11% in 2016

At the start of 2016, the current installed base of wearable activity tracking devices was just over 33 million in the U.S. This consumer market penetration is expected to grow by 11% in 2016, according to the Consumer Technology Association (CTA) forecast published in the 18th Annual Consumer Technology Ownership and Market Potential Study. Wearable tech comprises a very small piece of the larger consumer technology market, led by TVs, smartphones, headphones (wired), DVD players, and notebook/laptop/netbook computers, the four largest rectangles in the graphic. However, there is growth momentum for emerging consumer tech segments such as portable wireless speakers,

Comments(0)

The Battle of the Health Data Ecosystems, in The Huffington Post

My latest column on The Battle of the Health Data Ecosystems went live today in The Huffington Post. Read about the implications of the Nokia + Withings merger in the context of the launch of Apple’s CareKit, Under Armour’s Healthbox, and Google’s health data mine and analytics capabilities, all in the emerging health/medical era of The Internet of Things (IoT). A Fitbit tracking device played an important role in a recent story of the IoT in health/care. A patient was admitted to an emergency room with an irregular heartbeat after a grand mal seizure at work. The ER team didn’t have

Comments(0)

What Zero Kilometers Means for Food and Health

Italians get the food=health connection as a natural everyday behavior. So it’s no surprise that one of the fast-selling books in Italy’s librerias is about Slow Food – a movement that’s celebrating its 30th anniversary in that hot book by Carlo Petrini, a father of the Slow Food organization. I took the photograph this evening peering into a shop window during our post-dinner walk along the Via Gucciardini past the Giunti al Punto bookstore. [In full transparency, I’ve been a long-time member of this organization, represented by the little red snail icon.] The book has a three-word title: Buono, Pulito, Giusto. This

Comments(1)

It’s Good to Be Hawaiian When It Comes to Health – the 2015 States of Well-Being

Where you live in the U.S. is a risk factor for your health. Hawaii, Alaska, Montana, Colorado and Wyoming rank highest on the State of American Well-Being 2015 State Well-Being Rankings, the Gallup-Healthways Well-Being Index. Well-Being is based on an index of five components that people self-assess: purpose, social, financial, community, and physical. See the map: the darker blue the state, the healthier the population perceives itself to be. Note more light blue to the northeast and south, and dark blue in the mountain states, Alaska and Hawaii. Some states have stayed in the top-tier of wellness since 2012: Hawaii

Comments(0)

Retailers will morph into health destinations in 2016

Retailers in the U.S. are morphing into health destinations in 2016. Members of Target’s management team attended the 2016 Consumer Electronics Show (CES) and shared their perspectives in the company blog. Among the Target teams observations came from the Chief Marketing Officer, Jeff Jones, who observed, “A tidal wave of newness is coming to fitness technology and many companies are on the cusp of changing the game. From nutrition and sleep to how you exercise, it’s all going to be measured, linked and tracked. Wearables are here to stay and getting smarter every year.” The Senior Vice President for Hardlines,

Comments(1)

Activity Wearables on Black Friday 2015 – Doorbusters Abound

The 2015 holiday shopper can find activity trackers for gifting discounted as much as 50% and more over Thanksgiving weekend. In greater Philadelphia, the Thursday print newspaper ads were chock full of examples from Best Buy, Dick’s Sporting Goods, Kohl’s, Target, and Walmart, among others. Among the many “Doorbusters” and deep discounts were a Misfit Flash tracker for $14.99 at Best Buy (a 50% discount), a Fitbit Zip at both Kohl’s and Walmart for $39 ($20 off the manufacturers’ suggested retail price), and a Fitbit Flex at Dick’s Sporting Goods for $49.95 — 50% off full retail. That trackers are

Comments(0)

Social Determinants Impact Health More Than Health Care

The factors of where people are born, live, work and age — social determinants — shape human health more than health care. Yet in the U.S. much more resource per capita is funneled into healthcare services than into social ones. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity was published by The Kaiser Commission on Medicaid and the Uninsured in November 2015, calling attention to the opportunity and wisdom of baking health into all public policy. The social determinants of health (SDOH) include economic stability, the physical environment and neighborhood, education, food, community and

Comments(1)

The rise and rise of noncommunicable diseases

Noncommunicable diseases (NCDs) are the #1 cause of death in the world. NCDs are the yin to the yang of infectious diseases. Mortality from infectious disease has fallen as national economies have developed, while NCDs such as heart disease, respiratory disease, cancer, diabetes, and other NCDs are a growing burden. Health Affairs devotes its September 2015 issue to The Growing Burden of Noncommunicable Diseases, featuring research focusing both on global trends and U.S.-specific challenges. In their look into the relationships between NCDs, unhealthy lifestyles and country wealth, Thomas Bollyky et. al. note that NCDs aren’t only the “diseases of affluence,”

Comments(0)

Entresto – model for future Rx?

The FDA approved Novartis’s new heart failure drug Entresto (LCZ696) on July 7, 2015. This product was approved under the FDA fast track program which prioritizes therapies that fill unmet needs for patients with life-threatening conditions. Heart failure affects over 5 million people in the U.S. and is often caused by heart attacks and high blood pressure. So heart failure impacts lots of people and, in aggregate, the CDC says represents about $32 bn of medical spending annually in the U.S. and is a factor in 1 in 9 deaths in America each year. Novartis is looking to price Entresto as much

Comments(0)

Digital health mainstreams at CE Week 2015

Digital health is a fast-growing category of consumer electronics, and many new mobile and wearable health devices were featured at the 2015 CE Week held in New York City. The major themes of the “Fresh Gear” unveiled at the meeting included connected cars, connected home devices, 3-D printing, and a growing array of wristbands, apps, and wearable devices focused on the already-crowded health/wellness segment, and the emerging health/care area. The five I’ll focus on are good examples of digital health tech’s aimed at mainstream consumers shopping at retail at the middle of the market: an area that’s ripe to be served.

Comments(0)

Congratulations, Fitbit – what $4.1 bn looks like

When I clipped you to my underwear for the first time in 2011, I’d no idea that you were about to change my life, health and mindfulness. You were my first digital activity tracker and since then, I’ve purchased three versions of you…as well as others. Fitbit, you really did change my life and help me become more mindful of my activity, my calorie burn, ultimately supporting me in losing weight and keeping it off. Since its launch in 2009, the brand name “Fitbit” has become synonymous with digital activity tracking, the most popular digital pedometer on the market —

Comments(2)

Avoiding Wrinkles: A World Without Tobacco

May 31st is World No Tobacco Day, heralded by the World Health Organization, and celebrated by the advocacy group Action on Smoking and Health (with the very appropriate acronym ASH). Smoking is one of the most addictive (anti-)health behaviors around, so persuading people to quit the habit continues to challenge public health advocates. Enter ASH’s engaging campaign called “The Wrinkler,” with the introductory question, “Ever notice how some people who are 25 look 45?” The video continues to explain how we can “expedite the aging process….Ladies, wish you were half your age? Don’t wait for him to look younger; make yourself

Comments(0)

Purchase of wearable fitness trackers expected to grow in 2015, but one-half of Americans would “never” buy one

Headphones and smartphones are the top two electronics products U.S. consumers intend to purchase in 2015. But the emerging consumer electronics categories of wearable fitness trackers, smart watches, and smarthome devices (especially “smart” thermostats) are positioned to grow, too, in 2015, according to the 17th Annual CE Ownership and Market Potential Study from the Consumer Electronics Association (CEA). Wearable trackers have an installed base of about 17 million devices in the U.S., with 11% of U.S. households intending to purchase a tracker in 2015 — 6 percentage points up from 2014 (about a 50% increase over 2014). There are about 6 million smart

Comments(0)

Most people want to go digital for health – especially the un-well

2 in 3 people in the U.S. would use a mobile app to manage their health, especially for diet and nutrition, medication reminders, tracking symptoms, and recording physical activity. The fifth annual Pulse of Online Health survey from Makovsky finds that digital health is blurring into peoples’ everyday lives. We’ve covered previous Makovsky digital health surveys here on Health Populi; last year, we focused on consumers managing risk in digital health platforms, and in 2013, the state of seeking health information online. That most consumers would go beyond health information search to the more engaging pursuit of managing health over

Comments(1)

Physicians and mobile health – moving from “mobile” to simply “care”

February may be American Heart Month, African-American History Month, and Marfan Syndrome Awareness Month. But based on the volume of studies and reports published in the past two weeks, ’tis also the season for talking mobile health and doctors. This Health Populi post trend-weaves the findings. The big picture for mobile in health is captured by Citrix in its Mobile Analytics Report, dated February 2015. Everyday people are using mobile in work and daily living, blurring the distinctions between the various hats people wear. These roles, whether business or pleasure or life, happen 24×7, enabling through mobile platforms, Citrix found.

Comments(0)

Health and wellness at CES 2015 – trend-weaving the big ideas

Health is where we live, work, play and pray — my and others’ mantra if we want to truly bend (down) the cost curve and improve medical outcomes. If we’re serious about achieving the Triple Aim — improving public health, lowering spending, and enhancing the patient/health consumer experience (which can drive activation and ongoing engagement) — then you see health everywhere at the 2015 Consumer Electronics Show in Las Vegas this week. With this post, I’ll share with you the major themes I’m seeing at #CES2015 related to health, wellness, and DIYing medical care at home. The meta: from health care to self-care.

Comments(3)

Getting real about consumer demand for wearables: Accenture slows us down

Are you Feelin’ Groovy about wearables? Well slow down, you move too fast… …at least, according to Accenture’s latest survey into consumers’ perspectives on new technologies, published this week in conjunction with the 2015 Consumer Electronics Show in Las Vegas, the largest annual convention in the U.S. featuring technology for people. At #CES2015, we’re seeing a rich trove of blinged-out, multi-sensor, shiny new wearable things at the 2015 Consumer Electronics Show. Swarovski crystals are paired with Misfit Wearables, called the Swarovski Shine, shown here as a shiny new thing, indeed. Withings launched its Activite fitness tracking watch in new colors.

Comments(2)

The Internet of Healthy Me – putting digital health in context for #CES2015

Men are from Mars and Women, Venus, when it comes to managing health and using digital tools and apps, based on a poll conducted by A&D Medical, who will be one of several hundred healthcare companies exhibiting at the 2015 Consumer Electronics Show this week in Las Vegas. Digital health, connected homes and cars, and the Internet of Things (IoT) will prominently feature at the 2015 Consumer Electronics Show in Las Vegas this week. I’ll be attending this mega-conference, meeting up with digital health companies and platform providers that will enable the Internet of Healthy “Me” — consumers’ ability to self-track,

Comments(2)

Self-care is the new black in health care

Consumers’ growing health care cost burden is competing with other household spending: basic costs for Americans are eroding what’s left of the traditionally-defined Middle Class. At the front end of health costs is the health insurance premium, the largest single line item for a family. It looks like a big number because it is: Milliman gauged the cost for an employer to cover a family of four in a PPO in the U.S. at around $23K, with the employee bearing an increasing percent of the premium, copays, coinsurance, and a larger deductible this year than last, on average. There are

Comments(4)

Health on the 2014 Gartner Hype Cycle

Remote health monitoring is in the Trough of Disillusionment. Wearables are at the Peak of Inflated Expectations, with Big Data leapfrogging wearables from the 2013 forecast — both descending toward the Disillusionment Trough. Mobile (remote) health monitoring, however, has fallen into that Trough of Disillusionment as RHM has been undergoing reality checks in the health care system especially for monitoring and patient self-management of heart disease (most notably heart failure) and diabetes. Welcome to the 2014 edition of the Gartner Hype Cycle, one of my most-trusted data sources for doing health industry forecasts in my advisory work. Compared with last year’s

Comments(3)

Self-care – the role of OTCs for personal health financial management

Make-over your medicine cabinet. That’s a key headline for International Self-Care Day (ISD) on July 24, 2014, an initiative promoting the opportunity for people to take a greater role in their own health care and wellness. Sponsored by the Consumer Healthcare Products Association (CHPA), consumer products companies, health advocacy organizations, and legislators including John Barrow (D-GA), a co-sponsor of H.R. 2835 (aka the Restoring Access to Medications Act), the Day talked about the $102 billion savings opportunity generated through people in the U.S. taking on more self-care through using over-the-counter medicines. After the 2008 Recession hit the U.S. economy, industry analysts

Comments(1)

How smart do you want your home to be?

Smarter homes can conserve energy, do dirty jobs, and remind you to take your medicine. In doing all these things, smart homes can also collect data about what you do inside every single room of that home. The fast convergence of Wi-Fi and sensors are laying the foundation for the Internet of Things, where objects embedded with sensors do things they’re specially designed to do, and collect information while doing them. This begs the questions: what do you want to know about yourself and your family? How much do you want to know? And, with whom do you want to

Comments(4)

The battle of the bands, digital health style – live from #CEWeek in NYC

There’s a growing number of wearable digital health devices on the market, and more will appear at the 2015 Consumer Electronics Show in Las Vegas. Four new such products competed live today at CE Week’s Battle of the Bands, an event launched by Living in Digital Times. The competitors included GoQii, Healbe, Skulpt, and Wellograph, Wellograph calls itself “the world’s first wellness watch.” Made of sapphire crystal, the watch has a sleek design, targeting a working professional audience who wants a view on health throughout the day. The watch has an Integrated heart rate sensor, taking readings from the wrist for pulse,

Comments(3)

World No Tobacco Day v2014 – let’s raise (more) taxes on tobacco

Tomorrow is World No Tobacco Day. The use of tobacco is one of the most preventable public health issues on the planet. And the global tobacco epidemic contributed to 100 million deaths around the world in the 20th century. 6 million people die every year due to tobacco use — including 600,000 deaths due to exposure to secondhand smoke. About 500 million people living today will be dead from the use of tobacco products if current smoking habits continue, the World Health Organization (WHO) expects. WHO sponsors the World No Tobacco Day every year on May 31. For this year’s

Comments(0)

In a world of digital health data, more sick people trade off privacy risks

People managing chronic diseases are more likely to have accessed information in their electronic medical records — and are also less likely to worry about the privacy risks of their personal electronic health information compared with people who are healthy. Over 2,000 people, both those who say they’re healthy and those with chronic conditions, were surveyed by Accenture in February-March 2014, and their responses are summarized in the report, Consumers with Chronic Conditions Believe the Ability to Access Electronic Medical Records Outweighs Concern of Privacy Invasion. Slight more consumers are concerned about privacy risks related to online banking, online shopping,

Comments(0)

Wearable tech + the workplace: driving employee health

Employer wellness programs are growing in the U.S., bundled with consumer-directed plans and health savings accounts. A wellness company’s work with employee groups is demonstrating that workers who adopt mobile health technologies — especially “wearables” coupled with smartphone apps — helps change behavior and drive health outcomes. Results of one such program are summarized in Wearables at Work, a technical brief from Vitality, a joint venture of Humana and Discovery Ltd., published April 23, 2014. Vitality has been working in workplace wellness since 2005, first using pedometers to track workers’ workouts. In 2008, Vitality adopted the Polar heart rate monitor for

Comments(0)

The appification of health – a bullish outlook from Mobiquity

Over half of people using health and fitness apps began using them over six months ago, and one-half of these people who have downloaded health and fitness apps use them daily according to survey research summarized in the report, Get Mobile, Get Healthy: The Appification of Health and Fitness from Mobiquity. The company contracted a survey conducted among 1,000 U.S. adults in March 2014 who use or plan to use mobile apps to track health and fitness. Thus the “N” in this study was a group of people already interested in self-tracking health and not representative of the broader U.S. consumer

Comments(1)

Why a grocery chain supports health data liquidity

The CEO of a family-owned grocery store chain wrote a letter to New York State lawmakers to support $65 million worth of spending on a computer system for health information in the state. That grocer is Danny Wegman, and that project is the Statewide Health Information Network, aka SHIN-NY. In his letter beginning, “Dear New York Legislator,” Wegman identifies several benefits he expects would flow out of the health IT project: 1. Improve health care for all New Yorkers 2. Lower health care costs, through reducing hospital readmission rates and reducing duplicate testing. 3. Lead to health data “liquidity” (my

Comments(1)

Digital health is hot at South-by-Southwest #SXSH

Today kicked off the 2014 South-by-Southwest Festival (#SXSW) in Austin, TX, running until March 16 and featuring dozens of sessions, concerts, video, and fireside chats in music, film and interactive segments. I’ll be involved in an interactive session on Tuesday called “The Digital Health Bubble – Is It About to Burst?” This panel includes Marc Monseau (@MDMonseau) who is a pioneer in health and social media (building J&J’s early leadership in social health online); Marco Smit (@MrHealth20) who leads Health 2.0 Advisors and is a veteran strategist in several health/tech companies; and, Robert Stern, Founder/CEO of @PointofCare, a health IT platform that

Comments(0)

My Healthy Valentine: socialize health with your loved ones

Today, Valentine’s Day, is full of the signs of love. I’ve gotten several hugs and “I love you’s” from my daughter (a teenager – how fortunate am I?!); my husband returned home from a business trip in inclement weather, in time to share a romantic evening; my Facebook page has countless hugs and loving messages from friends near and far; and, I received real paper Valentine cards, old school style. But the best healthy Valentine gift I got was that my husband went for a check-up with his doctor, my daughter ate a great big breakfast before she went to

Comments(0)

A CT for $300 or $2,781 – why health price transparency matters

  Charges for medical, pharmacy and dental services can vary by more than 300%. This means that in one place, a procedure that costs $100 can cost $300 for the same treatment in another location or practice, discovered by Change Healthcare in their latest Healthcare Transparency Index 2013 Q3 Report, published in January 2014. The 300% is the average overall across dozens of health services used by the 67,000 plan members Change Healthcare analyzed based on health plan enrollees’ health care utilization in the third quarter of 2013. These health care services include office visits (behavioral health, physical therapy and

Comments(4)

What CVS going tobacco-free means for health and business

Bravo! to CVS/pharmacy who today announced it would pull tobacco products from store shelves by October 2014. “The sale of tobacco products is inconsistent with our purpose,” the company’s press release asserts. The move will cost CVS $1.5 billion in revenue annually, as the company seeks to consolidate its position as a health company. CVS/pharmacy is part of CVS Caremark, which includes the retail pharmacy chain (the second-largest in the U.S.), a pharmacy benefit management company (Caremark), and retail health clinics (Minute Clinics). CVS Caremark also participates in a healthy communities program issuing grants for projects that focus on health

Comments(6)

Connected Health – the technology is ready, providers on the cusp

The convergence of technology developments – such as the internet, mobile phone adoption, cloud computing, sensors, electronic health records – with societal evolution including consumerism, demand for transparency, and “flatter” organizations – enable the phenomenon of Connected Health. Connected Health by definition includes mobile health (mHealth), telehealth and telemedicine, as presented in the February 2014 issue of Health Affairs which is dedicated to this theme. Why Connected Health’s time is Now relates to those factors cited above, and the underlying challenge of managing health care costs. While all nations in the developed world are facing difficult health economies, the U.S. spends so

Comments(2)

Do People Really Want To Tech Their Health? in Huffington Post

This post appeared in my Huffington Post column on January 16, 2013. In the afterglow of the 2014 Consumer Electronics Show (CES), away from the neon lights of Las Vegas, 4D curved TV screens, and uber-hip Google Glass wearers, a big question remains: Do we, the people, really want to tech our way to self-health? The number of digital health companies exhibiting at CES grew by 40 percent, exceeding 300 based on the count of the International Consumer Electronics Association, sponsor of the event. The hockey-stick growth of “wearable technology” seen at the 2014 Consumer Electronics Show begs the question: Are there

Comments(2)

Schizo about smoking

There’s truly good news for public health about smoking: January 11th marked the 50th anniversary of the U.S. Surgeon General’s Report on Smoking and Health. That’s five decades’ worth of progress raising peoples’ awareness about the toxic impact of nicotine and chemicals embodied in cigarettes, and deleterious impacts on health and the economy. As a result, smoking rates have been cut in half since 1964, as the downward-sloping graph illustrates. With that happy news in my subconscious, I took a long walk, tracked by my digital device, through the Venetian Hotel in Las Vegas last week, bound for the 2014 Consumer Electronics

Comments(2)

Health Care Everywhere at the 2014 Consumer Electronics Show

When the head of the Consumer Electronics Association gives a shout-out to the growth of health products in his annual mega-show, attention must be paid. The #2014CES featured over 300 companies devoted to “digital health” as the CEA defines the term. But if you believe that health is where we live, work, play, and pray, then you can see health is almost everywhere at the CES, from connected home tech and smart refrigerators to autos that sense ‘sick’ air and headphones that amplify phone messages for people with hearing aids, along with pet activity tracking devices like the Petbit. If

Comments(1)

Wear It Well – Fashion Mashes Up With Health At #CES2014

Madame Onassis got nothing on you, Rod Stewart complimented in his hit You Wear It Well in 1972. Now we can all wear it well, based on the fashion-meets-health-mashups at the 2014 Consumer Electronics Show. Several events underline this observation at the CES this year: – Fitbit has signed up Tory Burch to put her mark accessorizing the company’s activity trackers – The CSR Bluetooth smart pendant was designed with the chic jeweler Cellini; the device can receive alerts from an iPhone (think: medication adherence, or a message from mom in Florida). This is featured in the first photo. –

Comments(2)

4 in 10 Americans keen to buy an app or device for health/fitness: Accenture’s 2014 digital lifestyle survey

Wearable technology is the new fashion accessory, Accenture observes in its 2014 survey report, Racing Toward a Complete Digital Lifestyle: Digital Consumers Crave More. In parallel with the supply-side growth of wearable technology that is seen this week at the 2014 Consumer Electronics Show, Accenture brings a sanguine story to the supply side of the equation, finding consumers “craving more” than one function from a digital device. Over one-half of consumers surveyed in six countries favored vehicle navigation, home safety/security monitors, health monitor, home comfort and control, fitness monitors, and personal safety monitors. Nearly one half (46%) liked smartwatches, and

Comments(0)

Sleep is the new black – digital health at the 2014 Consumer Electronics Show #CES2014

In the battle of wearable devices for digital health at this year’s Consumer Electronics Show, it’s sleep that’s the #1 new extension on activity tracking. Sleep, or lack thereof, is a prevalent challenge for people who increasingly live electronic lifestyles on-the-grid. And, lack of sleep is a major health risk for obesity, heart conditions, and mental acuity. A new Swedish study published in the peer-reviewed journal Sleep has found that sleep protects brain health. With the demise of the dedicated sleep device Zeo in 2013, popular sleep trackers with market shares have the opportunity to add sleep functions to their tools.

Comments(3)

mHealth will join the health ecosystem – prelude to the 2014 Consumer Electronics Show

The rise of digital health at the 2014 Consumer Electronics Show signals the hockey-stick growth of consumer-facing health devices for fitness and, increasingly, more medical applications in the hands of people, patients, and caregivers. This year at #CES2014, while the 40% growth of the CES digital health footprint will get the headlines, the underlying story will go beyond wristbands and step-tracking generating data from an N of 1 to tools that generate data to bolster shared-decision making between people and the health system, and eventually support population health. For example: – Aetna is partnering with J&J to deploy their Care4Today

Comments(2)

More chronically ill people use online health resources – but they’re not so social, Pew finds

People who are diagnosed with at least one chronic medical condition are more likely to seek information online, use social media to understand peer patients’ reviews on drugs and treatments, and learn from other patients about their personal health experiences. While that’s encouraging news for a health empowerment headline, the underlying challenge that should prevent congratulatory fist-bumps among patient-engagement proponents is that people living with chronic disease are less likely to have internet access. Why? Because chronically ill people tend to be older and less educated, and they’re also less likely to be working. Simply put, “People living with chronic

Comments(2)

Color us stressed – how to deal

Coast-to-coast, stress is the modus vivendi for most Americans: 55% of people feel stressed in every day life, according to a study from Televox. A Stressful Nation: Americans Search for a Healthy Balance paints a picture of a nation of physically inactive people working too hard and playing too little. And far more women feel the stress than men do. 64% of people say they’re stressed during a typical workday. 52% of people see stress negatively impacting their lives. And nearly one-half of people believe they could better manage their stress. As a result, physicians say that Americans are experiencing negative

Comments(0)

Mobile health apps – opportunity for patients and doctors to co-create the evidence

There are thousands of downloadable apps that people can use that touch on health. But among the 40,000+ mobile health apps available in iTunes, which most effectively drive health and efficient care? To answer that question, the IMS Institute for Healthcare Informatics analyzed 43,689 health, fitness and medical apps in the Apple iTunes store as of June 2013. These split into what IMS categorized as 23,682 “genuine” health care apps, and 20,007 falling into miscellaneous categories such as product-specific apps, fashion and beauty, fertility, veterinary, and apps with “gimmicks” (IMS’s word) with no obvious health benefit. Among the 23,682 so-called

Comments(7)

Getting to health engagement will require more than a patient portal

Patient and health engagement is the flavor du jour in health circles these days, from the corridors of hospitals to the caffeinated marketing meetings in Big Pharma’s east coast meet-ups. But there’s no standard agreement on what we mean by peoples’ health engagement, whether by patient or well consumer. In Market Insights: The Evolution of Consumer Engagement in Health Care, Porter Research endeavors to deepen our understanding of this important concept. In the introductory section of the paper, “Understanding Engagement,” Porter proffers that industry – providers, payers and employers – consider engagement as “changing consumer behavior through increased participation in consumers’ own health

Comments(2)

A new medical side-effect: out-of-pocket health care costs

When we say the phrase “side effects,” what do we think of? The FDA says that “all medicines have benefits and risks. The risks of medicines are the chances that something unwanted or unexpected could happen to you when you use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage.” There’s a new risk in town in health care, and it’s the equivalent of an upset stomach when it comes to a co-pay for a branded on-formulary drug, or liver damage if it involves a coinsurance percent of “retail”

Comments(0)

Delaying aging to bend the cost-curve: balancing individual life with societal costs

Can we age more slowly? And if so, what impact would senescence — delaying aging — have on health care costs on the U.S. economy? In addition to reclaiming $7.1 trillion over 50 years, we’d add an additional 2.2 years to life expectancy (with good quality of life). This is the calculation derived in Substantial Health And Economic Returns From Delayed Aging May Warrant A New Focus For Medical Research, published in the October 2013 issue of Health Affairs. The chart graphs changes in Medicare and Medicaid spending in 3 scenarios modeled in the study: when aging is delayed, more people qualify

Comments(0)

Economics of obesity and heart disease: We, the People, can bend the curves

The “O” word drives health costs in America ever-upward. Without bending the obesity curve downward toward healthy BMIs, America won’t be able to bend that stubborn cost curve, either. The Economic Impacts of Obesity report from Alere Wellbeing accounts for the costs of chronic diseases and how high obesity rates play out in the forms of absenteeism, presenteeism, and direct health care costs to employers, workers and society-at-large. Among the 10 costliest physical health conditions, the top 3 are angina, hypertension and diabetes — all related to obesity and amenable to lifestyle behavior change. The top-line numbers set the context:

Comments(2)

7 Women and 1 Man Talking About Life, Health and Sex – Health 2.0 keeping it real

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

Comments(3)

Health care and survey taking at the Big Box Store

Where can you shop the health and beauty aisles, pick up some groceries and a prescription, get a flu vaccine, and weigh in on Obamacare and what digital health tools you like? Why, at one of several thousand retail stores where you can find a SoloHealth kiosk. As of yesterday afternoon, over 32 million encounters were recorded on SoloHealth kiosks, based on an app I saw on the company CEO Bart Foster’s smartphone. Kiosks are locatted around the United States in retailers including Walmart and Sam’s Clubs, along with major grocery chains like Schnuck’s and Publix, and the CVS pharmacy

Comments(1)

Taking vitamins can save money and impact the U.S. economy – and personal health

When certain people use certain dietary supplements, they can  save money, according to a report from the Council for Responsible Nutrition and Frost and Sullivan, the analysts. The report is aptly titled, Smart Prevention – Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements. Its subtitle emphasizes the role of dietary supplements as a way to “combat unsustainable health care cost growth in the United States.” Specifically, the use of eight supplements in targeted individuals who can most benefit from them can save individuals and health systems billions of dollars. The eight money-saving supplements are: > Omega-3 > B

Comments(6)

Defining Mobile Health – the blur between health and health care

Mobilising Healthcare, a new report from Juniper Research, segments the mobile health sector into “healthcare” and “health & fitness” segments. The research summary notes that fitness is a relatively new market compared with health “care,” which has been around for eons. Fitness, the analysts say, “is exempt from government intervention.” Mobile healthcare (“mHealth”) applications explored include SMS health messaging, remote health provision such as cardiac monitoring, electronic health records and personal health records. In mFitness, Juniper looks into mobile tech for athletes and fitness conscious people, and activity tracking including heart function, distance, respiration, and perspiration, among other parameters. mHealth

Comments(0)

Health information search online, an hour a week. Time with a doctor? An hour a year.

In game-scoring unit terms, 52 is the number of hours an average American spends seeking health information online each year. The 1 (hour) is roughly equivalent to the approximate total time a patient spends with a physician (an average of 3 visits, with an average time per vision of 20 minutes). Thus, 52:1. This means that the average U.S. health consumer spends much more time DIYing her health using digital information resources than speaking face-to-face with their physician in the doctor’s office. Still, the physician continues to be a go-to source for health information, according to Makovsky, a health communications

Comments(5)

Chief Health Officers, Women, Are In Pain

Women are the Chief Health Officers of their families and in their communities. But stress is on the rise for women. Taking an inventory on several health risks for American women in 2013 paints a picture of pain: of overdosing, caregiver burnout, health disparities, financial stress, and over-drinking. Overdosing on opioids. Opioids are strong drugs prescribed for pain management such as hydrocodone, morphine, and oxycodone. The number of opioid prescriptions grew in the U.S. by over 300% between 1999 and 2010. Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men.

Comments(1)

Needing a new kind of tracker to track #mhealth investments in 2013

The news this week that Fitbit attracted $42 million investment capital follows Withings’ announcement of $30 million (including Euro11 million from BPIFrance, the French national investment fund), Jawbone’s recent acquisition of Bodymedia for $100 million in April 2013, and MyFitnessPal raising $13 million earlier this month. The quick arithmetic for these four companies alone adds to roughly $200 mm in a few months going to these brands, which are feverishly competing for the heartbeats and footsteps of people who are keen to track their steps and stay healthy. Can you keep up? You need a new kind of activity tracker to track

Comments(2)

Eat fruits and vegetables: it’s worth $11 trillion to you and the U.S. economy

More than 127,000 people die every year in America from cardiovascular disease, accruing $17 billion in medical spending. Heart disease is a “costly killer,” according to the Union of Concerned Scientists, who has calculated The $11 trillion reward: how simple dietary changes can save lives and money, and how we get there, published in August 2013. That $11 trillion opportunity is equal to the present value of lives saved. The solution to bolstering heart (and overall health) and saving money (medical spending and personal productivity) is in food. We’re not talking about genetically engineering anything special or out-of-the-ordinary. We are talking

Comments(0)

Healthways buys into Dr. Ornish’s approach: will “Ornish-inside” scale wellness in America?

People who live in U.S. cities with low levels of well-being have twice the rate of heart attacks as people who live in healthier America. That’s 5.5% of the population in sicker America versus 2.8% of the population living in healthy America. The first chart illustrates this disparity, taken from the Gallup-Healthways index that examined 190 metropolitan areas in 2012. Based on this study, it’s good to live in parts of Utah, Nebraska and Colorado, but not so healthy to be a resident in West Virginia, Alabama, and parts of Kentucky and Ohio. Heart disease and diabetes are killing a plurality

Comments(0)

Health and wellness, the economy and the grocery store

Consumers in America are spending more, and especially at the grocery store. Most people say they want to eat healthy — but, although they’re spending more at the food store, one-half of supermarket shoppers say cost is the main obstacle for healthy eating. 2 in 3 U.S. grocery shoppers define health and wellness as being physically fit and active, and over half believe that feeling good about yourself is another facet of health. Not being overweight equals health for about one-half of U.S. shoppers. The Why? Behind the Buy, from Acosta Sales & Marketing, explores buying patterns among U.S. consumers

Comments(0)

Cost prevents people from seeking preventive health care

3 in 4 Americans say that out-of-pocket costs are the main reason they decide whether or not to seek preventive care, in A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans from TeleVox, the communications company, published in June 2013. TeleVox surveyed over 1,015 U.S. adults 18 and over. That’s the snapshot on seeking care externally: but U.S. health consumers aren’t that self-motivated to undertake preventive self-care separate from the health system, either, based on TeleVox’s finding that 49% of people say they routinely exercise, and 52% say they’ve attempted to improve eating habits.

Comments(1)

1 in 3 people is interested in doing mobile health, but they skew younger

The headline for the HarrisInteractive/HealthDay mobile health (mHealth) survey reads, “Lots of Americans Want Health Care Via Their Smartphones.” But underneath that bullish forecast are statistics illustrating that the heaviest users of health care services in America — people 65 and over — have the least interest in mHealth tools. Overall, 37% of U.S. adults are interested in managing health via smartphones or tablets: about 1 in 3 people. As the chart shows, the greatest interest in communicating with doctors via mobile phones and tablets is among people 25-49. Reminders to fill prescription and participate in wellness programs is also

Comments(1)

The emerging economy for consumer health and wellness

The notion of consumers’ greater skin in the game of U.S. health care — and the underlying theory of rational economic men and women that would drive people to greater self-care — permeated the agenda of the 2nd annual Consumer Health & Wellness Innovation Summit, chaired by Lisa Suennen of Psilos Ventures. Lisa kicked off the meeting providing a wellness market landscape, describing the opportunity that is the ‘real’ consumer-driven health care: people getting and staying well, and increasing participation in self-management of chronic conditions. The U.S. health system is transforming, she explained, with payors beginning to look like computer

Comments(0)

Marketing Digital Health to Mom 2.0 on Mother’s Day 2013

Mainstream media, both print and online, peppered their 2013 Mother’s Day gift suggestions including pod coffeemakers, bangle bracelets, candy-colored accessories and digital health devices. Say, what? In Parade magazine, Mother’s Day 2013 gift ideas included the Fitbit “smart pedometer,” linked to a “buy” site at REI. You can’t get much more mainstream than Parade. In Entertainment Weekly, Bronwyn Barnes, style maven for the magazine, wrote a one-page “Get Ready for Mom 2.0” and her recommendations included the Pebble Smartwatch, the Jawbone Up wristband, and the HoodieBuddie with earbuds built into the drawstrings. Men’s Health told sons and husbands to check

Comments(1)

A physical activity shortage: Let’s Move!

Only 1 in 5 Americans got the minimum recommended amount of physical activity in 2011, based on guidelines offered by the U.S. Centers for Disease Control. More men than women met the standard: 23.4% of men versus 17.9% of women. There are wide variations across the 50 states, as the map shows, with the healthiest folks exercise-wise living in the west, Alaska, upper midwest, and New England. The range runs from a 12.7% low in West Virginia and Tennessee to 27.3 at the high end in Colorado. That bar is set at 150 minutes a week (that’s 2.5 hours) of

Comments(2)

Dietitians provide a health bridge between food and pharmacy

The registered dietitian is an in-demand labor resource for grocery stores around the U.S. Advertising Age covered the phenomenon of the growing clout of dietitians in food chains (April 14, 2013). Let’s dig further into this phenomenon through the Health Populi lens on healthcareDIY and peoples’ ability to bend their personal health care cost curves. Stores such as Giant Eagle, Hy-Vee, Safeway and Wegmans are morphing into wellness destinations, with pharmacies and natural food aisles taking up valuable square footage to meet consumers’ growing demands for healthy choices. Some stores are formalizing their approach to food = health by formulating a

Comments(2)

Food = Health for employers, hospitals, health plans and consumers

Food is inextricably bound up with health whether we are well or not. Several key area of the Food=Health ecosystem made the news this week which, together, will impact public and personal health. On the employer health benefits front, more media are covering the story on CVS strongly incentivizing employees to drop body mass index (BMI) through behavioral economics-inspired health plan design of a $50 peer month penalty. Michelin, whose bulky advertising icon Bibendum has more than one “spare tire,” introduced a program to combat health issues, including but not limited to BMI and high blood pressure, according to the

Comments(1)

Gettin’ higi with it: Lupe Fiasco’s foray into public health

The latest in SoLoMo (Social, Local, Mobile) Health is a gamified tool coupled with a hardware kiosk, known as higi. The brainchild of Michael Ferro, a successful dotcom entrepreneur who now owns the Chicago Sun-Times, higi’s mission is to help people – particularly younger peeps – to take better care of themselves by scoring points and, as a result, social connections. Higi’s an African word for origin, so the health tool has some aspects relating to being in a tribe — a kind of health tribe. It also has a fun sound to it, Ferro noted, which sets the vibe

Comments(4)

Health at SXSW13 vs. HIMSS13: the Yin, the Yang, and the Blur

I endured what very few people could (or would) do in the past ten days: I traveled to New Orleans to the annual conference of HIMSS, the Health Information Management Systems Society, which features hundreds of suppliers to the health care information technology industry. I returned home to kiss my family hello and goodbye, and a day later flew to Austin for the annual South-by-Southwest conference for music, movie and digital folks. The health track at SXSW has grown over the past five years, and provides a start contrast to “health care” as embodied at HIMSS, and “health” translated through

Comments(1)

The Sitting Disease: health is growing at SXSW

If it’s March, it must be time for South by Southwest (SXSW), the annual conference weaving music, film and interactive tracks of speakers and conferees that overcrowds and excites Austin, Texas, with a cool vibe and even cooler ideas. I’ll be participating on Sunday 10 March 2013 at 5 pm on a panel, Sitting Will Kill You: Can Mobile Save Us?, featuring Fran Melmed, developer of the HotSeat app that nudges us to all Get Up Offa Our Things when living our typical sedentary lives; Peter Katzmarzyk, public health researcher who knows all about the relationship between too much sitting

Comments(3)

Formally tracking health data changes health behavior and drives social health

Most of us keep track of some aspect of our health. Half of all people who track do so “in their heads,” not on paper, Excel spreadsheet, or via digital platform. Furthermore, 36% update their health tracking data at least once a day; but 16% update at most twice a month, and 9% update less than once monthly. Tracking for Health from the Pew Internet & American Life Project paints a portrait of U.S. adults who, on one hand are quantifying themselves but largely aren’t taking advantage of automated and convenient ways of doing so. Overall, 69% of U.S. adults track

Comments(3)

Think about health disparities on Martin Luther King Day 2013

On this day celebrating Martin Luther King, Jr., I post a photo of him in Detroit in 1963, giving a preliminary version of his “I Have a Dream” speech he would give two months later in Washington, DC. As I meditate on MLK, I think about health equity. By now, most rational Americans know the score on the nation’s collective health status compared to other developed countries: suffice it to say, We’re Not #1. But underneath that statistic is a further sad state of health affairs: that people of color in the U.S. have lower quality of health than white

Comments(4)

Battle of the (wrist)Bands at the Digital Health Summit, 2013 CES

One of the fastest-growing segments at the 2013 Consumer Electronics Show in Las Vegas this week is digital health. And within that segment, there’s a battle brewing for what technology companies seem to think is the most valuable part of real estate on the human body: the wrist. I counted at least fifty products as I cruised aisles 26000-27000 in the South Hall at the Las Vegas Convention Center that had wristbands, usually black, plastic or rubbery, and often able to click in and out of the band for use in-hand, in pocket, or in a few cases, on a

Comments(17)

We are all health deputies in the #digitalhealth era: live from the 2013 Consumer Electronic Show

Reed Tuckson of UnitedHealthGroup was the first panelist to speak at the kickoff of the Digital Health Summit, the fastest-growing aspct of the 2013 Consumer Electronics Show (#2013CES). Tuckson implored the spillover audience to all, “self-deputize as national service agents in health,” recognizing that technology developers in the room at this show that’s focused on developers building Shiny New Digital Things have much to bring to health. As Andrew Thompson of Proteus Medical (the “invisible pill” company) said, “we can’t bend the health care cost curve; we have to break it.” This pioneering panel was all about offering new-new technologies

Comments(1)

One-third of U.S. consumers plan to buy a new fitness tech in 2013, but most buyers are already healthy

Over one-third of U.S. consumers plan to buy a new fitness technology in the next year, especially women. They’ll buy these at mass merchants (females in particular, shopping at Target and Walmart), sporting goods retailers (more male buyers here), online and at electronics stores like Best Buy. These potential buyers consider themselves in good or excellent physical health. They’ll see the latest applications on retail store shelves in pedometers, calorie trackers, fitness video games, digital weight scales, and heart rate monitors that will be launched this week at the 2013 Consumer Electronics Show in Las Vegas. In advance of the

Comments(3)

Food and health: information is not doing the job as the U.S. continues its obesity march

Notwithstanding the fact that most phones on U.S. streets are “smart” ones, most adults surf the net for health information, and most people try to change a health habit each year, Americans haven’t adopted healthier long-term relationships with food. The International Food Information Council has conducted the Food & Health Survey: Consumer Attitudes Toward Food, Safety, Nutrition & Health poll since 2006, thus enabling us to track peoples’ attitudes and behaviors over the past several years. The latest polling results appear in Is it Time to Rethink Nutrition Communications? A 5-Year Retrospective of Americans’ Attitude toward Food, Nutrition, and Health online in

Comments(1)

Free statins at the grocery: retail health update

I spotted this sign yesterday at my local Wegmans, the family-owned grocery chain founded in upstate NY and growing down the northeast corridor of the U.S. Many months ago, a similar sign promoted “free antibiotics” at the store. What does a grocery chain’s pharmacy doling out “Free” [asterisked] generic Lipitor mean to the larger health ecosystem? On the upside, health is where we live, work, play and pray, as Dr. Regina Benjamin, the Surgeon General, has said. This has become a mantra for us at THINK-Health, and regular Health Populi readers may be tiring of my repeated use of this

Comments(6)

Health costs will increase in 2013, and employees will bear more: can wellness programs help stem the rise?

Health spending will increase by 7.5% in 2013, with employees’ contributions rising for in-network deductibles, prescription drugs and emergency room visits. 3 in 4 employers, seeking to control rising health expenses, will offer wellness programs, even though a vast majority can’t yet measure an ROI on them. The Health and Well-Being: Touchstone Survey Results from PriceWaterhouseCoopers (PwC). PwC points out that the 7.5% medical cost increase is historically lower than in recent years, as a result of structural changes in the health care market including: A sluggish economy Growing focus on cost containment Lower utilization of health services by patients Employers’ efforts

Comments(1)

Fruits, financial incentives and remote coaching: evidence for behavior change

Increasing intake of fruits and vegetables, coupled with remote health coaching and financial incentives, together help people adopt and maintain healthy behavior changes. This is the conclusion of a randomized controlled trial using mobile technology, published in the May 28, 2012, issue of Archives of Internal Medicine. Dr. Bonnie Spring of Northwestern University’s Department of Preventive Medicine led the study. The researchers developed the trial, called Make Better Choices, to sort out which behavior changes would enable people to reduce major risk factors for cardiovascular disease, cancer and diabetes. Four combinations were assessed in the intervention among 204 people: Increasing fruit

Comments(1)

Statins, food and a mobile app: Pfizer and Eating Well partner up as generic Lipitor hits the market

On May 23, 2012, Pfizer announced its teaming with EatingWell magazine to launch a mobile app for patients on Lipitor. Eight days later, on May 31, 2012, generic versions of Lipitor will hit the market. Lipitor is the best-selling drug in pharmaceutical history, to-date. Sales of the product top $125 billion. While generic atorvastatin has been available in the U.S. since November 2011 from two manufacturers, low prices for the generic will drop to $10 or less for a month’s supply at the end of May. This is Pfizer’s first foray into a prescription drug-affiliated app. The free mHealth app,

Comments(4)

It’s the prices and the technology, stupid: why U.S. health costs are higher than anywhere in the world

The price of physician services, proliferation of clinical technology and the cost of obesity are the key drivers of higher health spending in the U.S., according to The Commonwealth Fund‘s latest analysis in their Issues of International Health Policy titled, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, published in May 2012. The U.S. devotes 17.4% of the national economy to health spending, amounting to about $8,000 per person. The UK devotes about 10%, Germany 11.6%, France, 11.8%, Australia 8.7%, and Japan, 8.5%. On the physician pay front, primary care

Comments(2)

Right-sizing food and healthcare

In our fast-texting, quick-thinking, Blink-ing society, Jason Riis talks about slowing down our relationship with food. At the Edelman Wellness Ignited meet-up on March 26, 2012, Jason riffed on food  intervention and economics for healthy eating. Jason is a professor at Harvard Business School and among his many research interests is how to change culture to morph away from obesity and Type 2 diabetes toward health. The U.S. is a shopping nation: retail is destination, fun, entertaining, life, for millions of Americans. Jason’s asking what retailers can do about fast and food. This isn’t only about ‘fast food,’ which, of course,

Comments(0)

Wellness Ignited! Edelman panel talks about how to build a health culture in the U.S.

Dr. Andrew Weil, the iconic guru of all-things-health, was joined by a panel of health stakeholders at this morning’s Edelman salon discussing Wellness Ignited – Now and Next. Representatives from the American Heart Association, Columbia University, Walgreens, Google, Harvard Business School, and urban media mavens Quincy Jones III and Shawn Ullman, who lead Feel Rich, a health media organization, were joined by Nancy Turett, Edelman’s Chief Strategist of Health & Society, in the mix. Each participant offered a statement about what they do related to health and wellness, encapsulating a trend identified by Jennifer Pfahler, EVP of Edelman. Trend 1: Integrative

Comments(5)

Food = health: JWT foodspotting

35% of consumers who have been altering their food intake to lose weight are eating fewer processed foods, according to a recent Nielsen Global Survey. This percentage has grown from 29% in 2008. Health and wellness is one of three driving forces shaping food in 2012, according to JWT‘s What’s Cooking: Trends in Food. The other two forces, technology and foodie culture, combine with health/wellness and yield some interesting consumer trends in the milieu of food. JWT’s top food issues to watch are: – Fooducate – Nutrition scores – Fat taxes – Health and fresh vending machines – Gluten-free –

Comments(1)

Consumer electronics comes to health care — but don’t overestimate consumer demand just yet

More people with higher levels of concern about their health feel they are in good health, see their doctors regularly for check-ups, take prescription meds “exactly” as instructed, feel they eat right, and prefer lifestyle changes over using medicines. And 40% of these highly-health-concerned people have also used a health technology in the past year. At the other end of the spectrum are people with low levels of health concern: few see the doctor regularly for check-ups, less than one-half take their meds as prescribed by their doctors, only 31% feel they eat right, and only 36% feel they’re in

Comments(0)