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Be Thankful by Engaging With Grace and Talking About Your End-of-Life Wishes With Loved Ones

“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness. We each have our own stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma. Then there are the Rest-of-Us who share family stories and experience of long and painful endings, in institutional settings often coupled with costly, so-called “heroic” but unwanted futile care.

 

Life Expectancy Falls in the U.S., the Largest 2-Year Decline in 100 Years

Life expectancy at birth in 2021 in the United States fell to 76.1 years, the lowest level since 1996. Men fared much worse than women, with 73,2 years of life expectancy versus 79.1 years for women, the latest research from the CDC’s National Center for Health Statistics revealed.               In their Provisional Life Expectancy Estimates for 2021, the CDC kicks off a demographically detailed analysis with this simple line chart which graphs the dramatic decline in life expectancy at birth. The overall decline across gender and all race/ethnic groups was 2.7 years: 3.1 years

 

The Health of Older Americans in 2022 – Risks from the Pandemic, Isolation, and Social Determinants

For millions of older people in America, health and well-being got worse in the wake of the COVID-19 pandemic. Physical, mental and behavioral health took hits, depending on one’s living situation, social determinants of health risks, and even health plan, I write in the Medecision Liberate Health blog.                     In this essay on health disparities and equity for older adults, I weave together new data from, The United Health Foundation’s study on seniors’ health status in America’s Health Rankings for 2022 RAND and CMS research into seniors health disparities among Medicare Advantage

 

McKinsey’s Six Shifts To Add Life to Years — and One More to Consider

People spend one-half of their lives in “less-than-good health,” we learn early in the paper, Adding years to life and life to years from the McKinsey Health Institute. In this data-rich essay, the McKinsey team at MHI sets out an agenda that could help us add 45 billion extra years of higher-quality life equal to an average of six years per person (depending on your country and population demographics). The first graphic from the report illustrates four dimensions of health and the factors underneath each of them that can bolster or diminish our well-being: personal behaviors (such as sleep and diet),

 

People in the U.S. Without the Internet Were More Likely To Die in the Pandemic

Access to the Internet has been a key determinant of health — or more aptly, death — during the COVID-19 pandemic. Americans lacked Internet access were more likely to die due to complications from the coronavirus, according to a study published in JAMA Network Open this month. The study’s key finding was that for every additional 1% of people living in a county who have access to the Internet, between 2.4 and 6.0 COVID-19 deaths per 100,000 were preventable. The paper asserts that, “More awareness is needed about the essential asset of technological access to reliable information, remote work, schooling

 

Health Care Planning for 2022 – Start with a Pandemic, Then Pivot to Health and Happiness

One of my favorite Dr. Seuss characters is the narrator featured in the book, I Had Trouble In Getting to Solla-Sollew. I frequently use this book when conducting futures and scenario planning sessions with clients in health/care. “The story opens with our happy-go-lucky narrator taking  a stroll through the Valley of Vung where nothing went wrong,” the Seussblog explains. Then one day, our hero (shown here on the right side of the picture from the book) is not paying attention to where he is walking….thus admitting, “And I learned there are troubles of more than one kind, some come from

 

Effective Health Spending Is An Investment, Not a Cost: the Bottom-Line from OECD Health at a Glance 2021

“The pandemic has shown that effective health spending is an investment, not a cost to be contained: stronger, more resilient health systems protect both populations and economies,” the OECD states in the first paragraph of the organization’s perennially-updated report, Health at a Glance 2021. This version of the global report incorporates public health data from the “OECD35,” 35 nations from “A” to “U” (Australia to United States) quantifying excess deaths experienced during the COVID-19 pandemic, the obesity epidemic, mental and behavioral health burdens, and health care spending, among many other metrics. The first chart illustrates that calculation of excess deaths,

 

A Negative Outlook for US Hospital Margins Through 2021

In the fourth quarter of 2021, U.S. hospital margins will still be lower than before the COVID-19 pandemic, Kaufman, Hall & Associates project in their latest read on hospital finances. Kaufman Hall has been monitoring hospitals’ financial health in the coronavirus era since March 2020, month-by-month. This new report looks into the Financial Effects of COVID-19: Hospital Outlook for the Remainder of 2021. This report was conducted on behalf of the American Hospital Association (AHA), who succinctly summarized the forecast saying, “COVID-19 [is] expected to drive continued hospital losses throughout 2021.” That projection is further couched in the concern that

 

Digital Inclusion As Upstream Health Investment

Without access to connectivity during the pandemic, too many people could not work for their living, attend school and learn, connect with loved ones, or get health care. The COVID-19 era has shined a bright light on what some of us have been saying since the advent of the Internet’s emergence in health care: that digital literacies and connectivity are “super social determinants of health” because they underpin other social determinants of health, discussed in Digital inclusion as a social determinant of health, published in Nature’s npj Digital Medicine. On the downside, lack of access to digital tools and literacies

 

5.5 Million Years of Life Will Be Lost Due to COVID-19 in the U.S. in 2020

In 2020 in the U.S., 380,000 people are expected to die due to COVID-19. These people lost due to the coronavirus would, collectively, have lived another 5.5 million life-years would they not have succumbed to the virus. COVID-19 has cut lives short relative to their life expectancy, calculated in an analysis by the Pew Research Center based on CDC data from 2019 and 2020, coupled with additional statistics on life expectancy by age and gender. The bottom-line from the Pew Research Center’s analysis, simply stated, is that, “The pandemic…has killed many Americans who otherwise might have expected to live for

 

Nurses Hacking for Health and Compassionomics

The hearts and minds of nurses are fertile and inspirational sources and engines for health care innovation. This past weekend, and for the second time, I had the privilege and opportunity to be a panelist for the perennial hackathon meet-up of Nurse Hack 4 Health, sponsored by Microsoft, Johnson & Johnson, Sonsiel, and DevUp. This round, the hackathon attracted hundreds of nurses from at least 20 countries and 30 U.S. states. Even a few students attended, a growing trend as academia recognizes the shortage of workers trained to solve thorny problems of the world. In health care, right here, right

 

The Pandemic’s Death Rate in the U.S.: High Per Capita Income, High Mortality

The United States has among the highest per capita incomes in the world. The U.S. also has sustained among the highest death rates per 100,000 people due to COVID-19, based on epidemiological data from the World Health Organization’s March 28, 2021, update. Higher incomes won’t prevent a person from death-by-coronavirus, but risks for the social determinants of health — exacerbated by income inequality — will and do. I have the good fortune of access to a study group paper shared by Paul Sheard, Research Fellow at the Mossaver-Rahmani Center for Business and Government at the Harvard Kennedy School. In reviewing

 

The Cost of Healthcare Can Drive Medical Rationing and Crowd Out Other Household Spending

One in five people in the U.S. cannot afford to pay for quality health care — an especially acute challenge for Black and Hispanic Americans, according to a West Health-Gallup poll conducted in March 2021, a year into the COVID-19 pandemic. “The cost of healthcare and its potential ramifications continues to serve as a burdensome part of day-to-day life for millions of Americans,” the study summary observed. Furthermore, “These realities can spill over into other health issues, such as delays in diagnoses of new cancer and associated treatments that are due to forgoing needed care,” the researchers expected. The first table

 

How Fruits and Veg Can Make Health and Lower Costs – Calling Chef José Andrés to the White House

Springtime is finally emerging on the east coast of the U.S. and my local CSA farm is on my mind. It’s timely, then, to re-visit a research paper on subsidizing fruits and vegetables from a March 2019 issue of PLOS as an introduction to a new initiative growing out of The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) on produce prescriptions. Timely, too, that Chef José Andrés has been called to President Biden’s White House to help address food security in America. First, let’s look at the research in PLOS: Cost-effectiveness of financial incentives for

 

The Ongoing Reality of COVID-19 – My Conversation with Dr. Michael Osterholm at SXSW

“So close and yet so far” feels like the right phrase to use a year after the World Health Organization used the “P-word,” “pandemic,” to describe the coronavirus’s impact on public health, globally. One year and over 550,000 COVID-related deaths in the U.S. later, we face a New Reality that Dr. Michael Osterholm and I are brainstorming today at the 2021 South-by-Southwest Festival. Usually held live and very up-close-and-personally crowded in Austin, Texas, this year we are all virtual — including the film, music, and interactive festivals alike. While I regret to not be in the same room as Dr.

 

A BA Degree as Prescription for a Longer Life – Update on Deaths of Despair from Deaton and Case

“Without a four-year college diploma, it is increasingly difficult to build a meaningful and successful life in the United States,” according to an essay in PNAS, Life expectancy in adulthood is falling for those without a BA degree, but as educational gaps have widened, racial gaps have narrowed by Anne Case and Angus Deaton. Case and Deaton have done extensive research on the phenomenon of Deaths of Despair, the growing epidemic of mortality among people due to accidents, drug overdoses, and suicide. Case and Deaton wrote the book on Deaths of Despair (detailed here in Health Populi),  Case and Deaton

 

2020 Was Our Year of COVID; 2021 Will Be Our Year of Vaccines and Excess Deaths in America

With a third vaccine approved by the FDA for licking COVID-19, brought to market by Johnson & Johnson, the U.S. can expect an uptick in vaccinations among fellow health citizens. That’s such welcome news and a positive outlook for a healthier 2021. But there’s another angle on 2021 for which health care providers and health citizens alike should prepare: that is the excess deaths that will happen due to patients postponing needed health care, diagnostic tests, and preventive services that stem from people avoiding care in doctor’s offices and hospitals. The chart here comes from IQVIA’s latest study into COVID-19’s

 

Americans Lost Future Life-Years in 2020: How Much Life Was Lost Depends on the Color of One’s Skin

Some people remark about 2020 being a “lost year” in the wake of the coronavirus pandemic. That happens to be a true statement, sadly not in jest: in the U.S., life expectancy at birth fell by one full year over the first half of 2020 compared with 2019, to 77.8 years. In 2019, life expectancy at birth was 78.8  years, according to data shared by the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC). Life expectancy at birth declined for both females and males, shown in the first chart. The differences between

 

Three in Four People Avoiding Health Care in the Pandemic Have Had Chronic Conditions

By the autumn of 2020, U.S. physicians grew concerned that patients who were avoiding visits to doctor’s offices were missing care for chronic conditions, discussed in in Delayed and Forgone Health Care for Nonelderly Adults during the COVID-19 Pandemic from the Urban Institute. More than three-fourths of people who delayed or forewent care had at least one chronic health condition. The pandemic may have led to excess deaths from diabetes, dementia, hypertension, heart disease, and stroke, as well as record drug overdoses in the 12 months ending in May 2020. In their JAMA editorial on these data, Dr. Bauchner and

 

The Biden Administration’s Whole-of-Government Approach to Equity – in Health and Beyond

In the U.S., the COVID-19 pandemic has revealed disparities in housing, food, and job security, and the role that one’s ZIP code and social determinants play in health outcomes. Overall, America has done poorly in light of being 4% of the world’s population but having one-fifth of the planet’s deaths due to the coronavirus. But these have disproportionately hit non-white people, who are nearly three times as likely to die from COVID-19 than white Americans. I’ve been head-down reviewing the first two days of President Biden’s signing Executive Orders, reading the National Strategy for COVID-19 Response, and inventorying line items

 

“The virus is the boss” — U.S. lives and livelihoods at the beginning of 2021

“The virus is the boss,” Austan Goolsbee, former Chair of the Council of Economic Advisers under President Obama, told Stephanie Ruhle this morning on MSNBC. Goolsbee and Jason Furman, former Chair of Obama’s Council of Economic Advisers, tag-teamed the U.S. economic outlook following today’s news that the U.S. economy lost 140,000 jobs — the greatest job loss since April 2020 in the second month of the pandemic. The 2020-21 economic recession is the first time in U.S. history that a downturn had nothing to do with the economy per se. As Uwe Reinhardt, health economist guru, is whispering in my

 

Will 2021 Be the Year of Sicker Americans? Pondering Late 2020 Data from IQVIA

Yesterday, IQVIA presented their end-of-year data based on medical claims in the U.S. health care system tracking the ups, downs, and ups of the coronavirus in America. IQVIA has been tracking COVID-19 medical trends globally from early 2020. The plotline of patient encounters for vaccines, prescribed medicines, foregone procedures and diagnostic visits to doctors begs the question: in 2021, will Americans be “sicker,” discovering later-stage cancer diagnoses, higher levels of pain due to delayed hip procedures, and eroded quality of life due to leaky guts? Here are a few snapshots that paint a picture for greater morbidity and potentially more “excess

 

My ABCovid-19 Journal – Day 3 of 5, Letters “K” through “O”

Welcome back to my ABCovid-19 Journal, which I created/curated in the early weeks of the coronavirus pandemic. This week, I’m sharing all the letters of the alphabet with you which reminded me keywords and themes emerging as we were learning about this dastardly public health threat beginning early in 2020. In today’s Health Populi blog I bring you letters “K” through “O,” continuing through the rest of the alphabet tomorrow and Friday while I’m on a lake-side holiday that’s good for mind, body, and spirit. K is for Kirkland, Washington state In the U.S., one of the earliest hotspots for

 

My ABCovid-19 Journal – Day 1 of 5, “A” through “E”

My friends… It’s time in this pandemic journey that I take a full week to re-charge and bask in the midst of nature, a lake, farm-to-table food, wine-making, and the love of and therapeutic time with my wonderful husband. My gift to you all this week, 10th – 14th August, is to share with you pages from my “ABCovid-19 Journal” that I created/curated in the first weeks of the coronavirus pandemic. We all have our hacks for managing stress and discomfort, and in the first weeks of COVID-19, this was my life-saver. Journaling is one of my self-care strategies; think

 

The Racial Divide Due to COVID-19 Also Applies to Healthcare and Pharma Costs

Into the sixth month of the coronavirus pandemic in the U.S., it’s clear that COVID-19 has wreaked a greater mortality and morbidity impact on people of color than on white adults. A new Gallup-West Health poll found that the coronavirus also concerns more non-white Americans than whites when it comes to the cost of health care and medicines to deal with the effects of COVID-19. Considering the cost of COVID-19 treatment, across all U.S. adults, 40% of people are concerned (extremely/concerned), and 41% are “not at all concerned.” Broken down by race, there is a stark difference in levels of

 

The Unsurprising Surprise of Social Determinants in COVID-19 Mortality

“Covid-19 exposes America’s racial health gap,” asserts The Economist, the weekly news magazine based in London, UK, in an advanced essay dated 11 April 2020. The subtitle of the piece: “African-Americans appear more vulnerable to the virus.” The phrase, “your ZIP code is more important than your genetic code” has become the common mantra for public health people communicating the concept of the social determinants of health: those factors outside of medical services that shape peoples’ overall health and well-being. Two days ago, the Centers for Disease Control (CDC) published data that showed African-Americans were dying from complications of the

 

West Virginia Was the Last State to ID a COVID-19 Positive Patient; The States’ Residents Are At Highest Risk for Severe Reaction to C19

Gallup has estimated 11 Million in U.S. at Severe Risk If Infected With COVID-19 in research published today. And the health citizens of West Virginia would be at greatest risk for having a severe reaction to the coronavirus. A “severe reaction” here means being critically ill or dying. The forecast doesn’t focus on the whole number of people in the US. who would be at-risk of contracting the coronavirus; the 11 million is the total number of Americans who have a “very high chance of becoming critically ill or dying” if 100% of the country were infected with C19. This

 

The Suicide Rate in America Increased by 40% between 2000 and 2017. Blue Collar Workers Were Much More At Risk.

The rate of suicide in the U.S. rose from 12.9 per 100,000 population to 18.0 between 2000 and 2017, a 40% increase. Those workers most at-risk for suiciding were men working in construction and mining, maintenance, arts/design/entertainment/sports/media, farming and fishing, and transportation. For women, working in construction and mining, protective service, transportation, healthcare (support and practice), the arts and entertainment, and personal care put them at higher risk of suicide. The latest report from the CDC on Suicide Rates by Industry and Occupation provides a current analysis of the National Violent Death Reporting System which collects data from 32 states,

 

The 2020 Social Determinants of Health: Connectivity, Art, Air and Love

Across the U.S., the health/care ecosystem warmly embraced social determinants of health as a concept in 2019. A few of the mainstreaming-of-SDoH signposts in 2019 were: Cigna studying and focusing in on loneliness as a health and wellness risk factor Humana’s Bold Goal initiative targeting Medicare Advantage enrollees CVS building out an SDOH platform, collaborating with Unite US for the effort UPMC launching a social impact program focusing on SDoH, among other projects investing in social factors that bolster public health. As I pointed out in my 2020 Health Populi trendcast, the private sector is taking on more public health

 

Longevity Stalls Around the World And Wealth, More Concentrated

Two separate and new OECD reports, updating health and the global economic outlook, raise two issues that are inter-related: that gains in longevity are stalling, with chronic illnesses and mental ill health affecting more people; and, as wealth grows more concentrated among the wealthy, the economic outlook around most of the world is also slowing. First, we’ll mine the Health at a Glance 2019 annual report covering data on population health, health system performance, and medical spending across OECD countries. The first chart arrays the x-y data points of life expectancy versus health spending for each of the OECD countries

 

Social Determinants of Health – My Early Childhood Education and Recent Learnings, Shared at the HealthXL Global Gathering

My cousin Arlene got married in Detroit at the classic Book Cadillac Hotel on July 23, 1967, a Sunday afternoon wedding. When Daddy drove us back out to our suburban home about 30 minutes from the fancy hotel, the car radio was tuned to WWJ Newsradio 950, all news all the time. As soon as Daddy switched on the radio, we were shocked by the news of a riot breaking out in the city, fires and looting and gunshots and chaos in the Motor City. Two days later, my father, who did business with Mom-and-Pop retail store owners in the

 

Art As Medicine – WHO Weaves the Evidence for Arts’ Role in Improving Health

“What’s the evidence on the role of the arts in improving health and well-being?” asks a report from the World Health Organization‘s Europe region team (WHO-Europe). There’s a lot of proof supporting arts-as-medicine, WHO details in this paper, which synthesizes research published in over 3,000 studies. The first chart illustrates the logic model that bridges arts to health in three segments: “Components” of arts programs, including but not limited to cognitive stimulation (e.g., learning a new arts skill such as painting, drawing or journaling), social interaction (e.g., participating in theatre), physical activity (e.g., dance), and evocation of emotion (e.g., listening

 

A Tale of Two Americas as Told by the 2019 OECD Report on Health

It was the best of times, It was the worst of times, It was the age of wisdom, it was the age of foolishness, It was the epoch of belief, it was the epoch of incredulity, … starts Dickens’ Tale of Two Cities.  That’s what came to my mind when reading the latest global health report from the OECD, Health at a Glance 2019, which compares the United States to other nations’ health care outcomes, risk factors, access metrics, and spending. Some trends are consistent across the wealthiest countries of the world, many sobering, such as: Life expectancy rates fell in 19 of the

 

Making Health Care Better, from the N of 1 to the Public’s Health – Trend-Weaving Medecision Liberation 2019

Health and our health information are deeply personal. Changing health care and inspiring positive health behaviors is hard to do. But we must and we will, a group of inspiring and inspired people who work across the health/care ecosystem affirmed this week in Dallas at the conference of Medecision Liberation 2019. I was engaged at this conference to wear several hats — as a keynote speaker, a sort of “emcee,” and, finally, to trend-weave the many talks and discussions happening throughout the meeting. This post is my synthesis of the summary I delivered live at the end of the conference,

 

The Number of Unintended Deaths From Car Accidents, Falls and Overdoses in America Grew 40% Between 1999 and 2017

The rate of deaths due to unintentional injuries in the U.S. grew by 40% between 1999 and 2017, according to the Centers for Disease Control (CDC). Three mortality line items make up this overall statistic: Deaths from motor vehicle traffic injuries Deaths from unintentional drug overdoses (that is, not including suicides which are defined as “intentional”), and Deaths due to unintentional falls. The line graph illustrates the macro trend on the top-line, with the three specific causes underneath. You see deaths due to falls, motor vehicle accidents, and drug overdoses increased over the eighteen years. Drug overdose death rates began

 

Gaps in Health Equity in America Are Growing

There’s been a “clear lack of progress on health equity during the past 25 years in the United States,” asserts a data-rich analysis of trends conducted by two professors/researchers from UCLA’s School of Public Health. The study was published this week in JAMA Network Open. The research mashed up several measures of health equity covering the 25 years from 1993 through 2017. The data came out of the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System looking at trends by race/ethnicity, sex and income across three categories for U.S. adults between 18 and 64 years of age.

 

Health Care and the Democratic Debates – Round 2 – Battle Royale for M4All vs Medicare for All Who Want It – What It Means for Industry

Looking at this photo of the 2020 Democratic Party Presidential candidate debater line-up might give you a déjà vu feeling, a repeat of the night-before debate. But this was Round 2 of the debate, with ten more White House aspirants sharing views — sometimes sparring — on issues of immigration, economic justice, climate change, and once again health care playing a starring role from the start of the two-hour event. The line-up from left to write included: Marianne Williamson. author and spiritual advisor John Hickenlooper, former Governor of Colorado Andrew Yang. tech company executive Pete Buttigieg, Mayor of South Bend,

 

Will Health Consumers Morph Into Health Citizens? HealthConsuming Explains, Part 5

The last chapter (8) of HealthConsuming considers whether Americans can become “health citizens.” “Citizens” in this sense goes back to the Ancient Greeks: I return to Hippocrates, whose name is, of course, the root of The Hippocratic Oath that physicians take. Greece was the birthplace of Democracy with a capital “D.” Hippocrates’ book The Corpus is thought to be one of the first medical textbooks. The text covered social, physical, and nutritional influences, and the concept of “place” for health and well-being. Here, the discussion detailed the roles of air and water for health. The Hippocratic texts also coached doctors to

 

What We Know We Know About ZIP Codes, Food, and Deaths of Despair – HealthConsuming Explains, Part 3

“There’s a 15-year difference in the life expectancy between the richest and poorest Americans.” That’s the first sentence of Chapter 7 in my book, HealthConsuming: From Health Consumer to Health Citizen. This data point comes from research published in JAMA in April 2016 on the association between income and life expectancy in the U.S. (That’s endnote #399 in the back of the book, one of 519 notes I use to support the plotline). Today, the Brookings Institution convened a meeting on the funding for social determinants of health to address disparities, costs, and quality of healthcare in America. The overall

 

World Health Day 2019: Let’s Celebrate Food, Climate, Insurance Coverage and Connectivity

Today, 7 April, is World Health Day. With that in mind, I devote this post to three key social determinants of health (SDOH) that are top-of-mind for me these days: food for health, climate change, and universal health coverage. UHC happens to be WHO’s focus for World Health Day 2019. [As a bonus, I’ll add in a fourth SDOH in the Hot Points for good measure and health-making]. Why a World Health Day? you may be asking. WHO says it’s, “a chance to celebrate health and remind world leaders that everyone should be able to access the health care they need,

 

The Ultimate Health Outcome, Mortality, Is Rising in America

How long can people living in the U.S. expect to live? 78.6 years of age, if you were born in 2017. That’s a decline of 0.1 year from 2016. This decline especially impacted baby boys: their life expectancy fell to 76.1 years, while baby girls’ life expectancy stayed even at 81.1 years. That’s the latest data on Mortality in the United States, 2017, soberly brought to you by the Centers for Disease Control and Prevention, part of the U.S. Department of Health and Human Services. Underneath these stark numbers are the specific causes of death: in 2017, more Americans died

 

Obese, Access-Challenged and Self-Rationing: America’s Health Vs Rest-of-World

          The U.S. gets relatively low ROI for its relatively exorbitant spending on healthcare, noted once again in the latest Health at a Glance, the annual OECD report on member nations’ healthcare systems. The report includes U.S. country data asking, “How does the United States compare?” with its sister OECD countries. The answer is, “not well across most population health, access, and mortality measures.” For the Cliff’s Notes/Where’s Waldo top-line of the research, find the two long bars in this chart heading “south” of the OECD average, and one long blue bar going “north.” The northern climbing bar

 

Thinking About Kate and Anthony – Suicide and Depression Is US

Yesterday at 1 pm, we learned that the incidence of suicide is up in America in a report from the Centers for Disease Control (CDC), an agency in the U.S. Department of Health and Human Services. This morning, we awake to news that Anthony Bourdain, the witty and prolific travel and food expert, took his own life. Earlier this week, Kate Spade, fashion designer and creative force, took her own life. The loss of these two bright lights, gone from our lives to suicide within a few days of each other, gives me the sad compulsion to say something, again, about

 

The U.S. is a Nation in Pain – America’s Life Expectancy Fell Again in 2016

American saw the greatest number of deaths from suicide and alcohol- and drug-induced fatalities was recorded in 2016. That statistic of nearly 142,000 equates to deaths from stroke and exceed the number of deaths among Americans who died in all U.S. wars since 1950, according to Pain in the Nation Update from the Well Being Trust and Trust for America’s Health. The line graph soberly illustrates the growing tragic public health epidemic of mortality due to preventable causes, those deaths of despair as Anne Case and Sir Angus Deaton have observed in their research into this uniquely all-American phenomenon. While this

 

A Tale of Two America’s for Health

  Disparities in Americans’ health vary among people living in each of the 50 states. These differences in health status generally fall into two regions: north and south, found in the Commonwealth Fund’s 2018 Scorecard on State Health System Performance. The map shows this stark geography-is-health-destiny reality: the worse-than-average states, the Fund found, run from Nevada southeast to Arizona, through New Mexico and Texas all the way to Atlantic Ocean and the Carolinas, then north west all the way up through the industrial Midwest states through Michigan to the north. Wyoming is the only non-contiguous state in the worse-performing U.S. state

 

Engage With Grace and Your Family on Thanksgiving: Have an End-Of-Life Chat at the End-Of-the-Feast

“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness. We each have our stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma. Then there are the Rest-of-Us who share family stories and experience of long and painful endings, in institutional settings often coupled with costly, so-called “heroic” bit unwanted, futile care. When you’re

 

U.S. Healthcare Spending & Outcomes in Five Charts: #EpicFail in the 2017 OECD Statistics

“Spend more. Get less.” If a retailer advertised using these four words, how many consumers would buy that product or service? This is the American reality of healthcare spending in 2016, told in the OECD report, Health at a Glance 2017. I present five charts from the study in this post, which together take the current snapshot health-economic lesson for the U.S. First, look at health expenditures as a share of gross domestic product: the U.S. is number one above Switzerland, France, and the UK, and about two times the OECD average. Note, too, the proportion of out-of-pocket and so-called

 

Income Inequality For Older Americans Among Highest in the World – What This Means for Healthcare

Old-age inequality among current retirees in the U.S. is already greater than in ever OECD country except Chile and Mexico, revealed in Preventing Ageing Unequally from the OECD. Key findings from the report are that: Inequalities in education, health, employment and income start building up from early ages At all ages, people in bad health work less and earn less. Over a career, bad health reduces lifetime earnings of low-educated men by 33%, while the loss is only 17% for highly-educated men Gender inequality in old age, however, is likely to remain substantial: annual pension payments to the over-65s today are

 

How We Live and Die in 2017: Obesity, Conflict and Mental Illness

Obesity, conflict, and mental illness contribute most to the ill health and mortality of the world’s population – especially in the U.S., according to the annual Global Burden of Disease study published this month in The Lancet and funded by The Bill & Melinda Gates Foundation. There’s good news and bad news in this research: on the upside, people are living longer. On the downside, there’s a lot of morbidity – that is, sub-optimal health – in those years. The study examines both YLLs (years of life lost) and YLDs (years lived with disability). “Death is a powerful motivator, both

 

Talk #EndOfLife at the End of the Thanksgiving Meal: Engage With Grace

“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness. We each have our stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma. Then there are the Rest-of-Us who have the stories of long and painful endings, in institutional settings and costly, futile care. When you’re already in the situation of making tough health

 

Color Me Well – Coloring Books As Rx for Wellness

Coloring books are best sellers in bookstores, craft merchandisers, newspaper stands, and on Amazon. Now, they’re joining the health and wellness world. The market growth of coloring books has been recognized in national media like the Washington Post, who called the phenomenon, “a bright spot in the financial results of publishers and retailers alike.” Nielsen Bookscan estimated that 12 million were sold in 2015, up from 1 million in 2014. Publishers Weekly covered the craze in November 2015. A Forbes column said, “The adult coloring craze continues and there is no end in sight.” Some of the mental health benefits

 

Palliative Care: Getting End of Life Care (W)right

I lost a best friend last week. His memorial service, held this past weekend, was a celebration of his life. And part of that well-lived life was a very conscious planning of his last days. The Economist published its 2015 Quality of Death Index, a data-driven treatise on palliative care, the very week my dear friend Rick died. This gives me the opportunity to discuss palliative care issues with Health Populi readers through The Economist’s lens, and then in the Hot Points below through my personal context of this remarkable man’s end-of-life choices. The Economist ranks 80 countries on several

 

Doctors who write right: Gawande, Topol and Wachter put people at the center of health/care

There’s a trifecta of books written by three brilliant doctors that, together, provide a roadmap for the 21st century continuum of health care: The Patient Will See You Now by Eric Topol, MD; The Digital Doctor from Robert Wachter, MD; and, Being Mortal, by Atul Gawande. Each book’s take provides a lens, through the eyes of a hands-on healthcare provider, on healthcare delivery today (the good, the warts and all) and solutions based on their unique points-of-view. This triple-review will move, purposefully, from the digitally, technology optimistic “Gutenberg moment” for democratizing medicine per Dr. Topol, to the end-game importance of

 

Learning from Mr. Spock and Leonard Nimoy about living long and prospering

“Live long and prosper,” Mr. Spock repeated, like a mantra, throughout his life. We say goodbye, on this dimension anyway, to Leonard Nimoy, who passed away today at the age of 83. Star Trek is a staple entertainment — perhaps even a relaxation therapy — in my home. So Mr. Nimoy’s departure from the Planet is indeed a sad event here. In thinking about Spock’s mantra about living well, I am reminded of an interchange between him and Captain Kirk in the Star Trek movie, The Wrath of Khan. In that film, Spock is severely irradiated while saving the ship, and

 

Be thankful for your good life. Now think about what a good death would be.

This Thanksgiving, we’re once again participating in the annual Engage With Grace blog rally, encouraging those who haven’t considered their end-of-life preferences to start thinking about them, and asking those who have done it to consider how their decisions may have changed over time. It’s good food for thought. Wishing you all a happy, healthy holiday season.  Most of us find ourselves pretty fascinating… flipping through photos and slowing down for the ones where we’re included, tweeting our favorite tidbits of information, Facebook-ing progress on this or that… We find other people captivating as well.  In fact, there’s a meme going around