A blog covering the health/care ecosystem and people.

The presence of health and medicine is growing at CES, the annual conference of all-things-tech for consumers. At this week’s Show in Las Vegas, we see that the Internet of Healthy Things (a phrase coined by Dr. Joe Kvedar) has taken hold and gone mainstream in remote health monitoring, wearable tech, and heart rate tracking which is now embedded (and expected by health-seeking consumers) in wristbands. An expanding category in the Internet of Healthy Things is oral care. Let’s call this the Internet of Teeth, yet another riff on “IoT.” Of course, oral health goes well beyond teeth and toothbrushes.

Today is Day 1 of two Media Days at #CES2020 in Las Vegas, kicking off this manic week of the Consumer Electronics Show at the Mandalay Bay convention center. For several years, I’ve convened with journalists and industry analysts from around the world for these two days before the “official” opening of CES to hear the latest news from some of the largest tech-focused companies on Earth. Announcements come from across industry sector — from automotive and transportation, telecoms, consumer goods, entertainment, social media, travel, and retail…with platform technologies playing a role including but not limited to AI, AR/VR/XR (the

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

There’s something like cognitive dissonance as I prepare my 2020 Health Populi TrendCast of what to expect in the health/care ecosystem in the new year. One of my key pillars for health-making is food-as-medicine, and that opportunity in this moment resonates in this holiday season with Dickens’ “Best of Times, Worst of Times” context-setting that kicks off Great Expectations. In the “best of times” part of the food+health equation, we recognize the growing role of grocery stores, food-tech and food manufacturers in the health/care landscape. A current example comes from Kroger, partnering with Ascension’s health system in Tennessee, enhancing the organization’s

“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

The market for caregiving is growing and the business community has, finally, begun to pay attention. The Washington Post referred to this market as a “gold rush” to design smart shoes, custom razors and technology for the “over-65 crowd.” Caregiving in the U.S., the seminal report from AARP, estimated that 43,5 million adults in the U.S. had provided unpaid care to an adult or child in the past year, about one in five people being caregivers. Over half of caregivers are women, and are about 49 years of age on average. Caregivers spent over 24 hours a week providing care go

SelfCare is health/care, particularly as patients, everyday people, take on greater responsibility for clinical decisions and paying for medical services. We’re convening today through Sunday in Indianapolis with GMDC, the Global Market Development Center and Retail Tomorrow to brainstorm the current and future prospects for SelfCare, health and wellness in the hands, hearts, and homes of consumers. To bolster the message and engage with industry stakeholders, GMDC collaborated with the Hamacher Resource Group to develop a SelfCare Roadmap, an interactive tool that provides insights into twelve conditions where consumers typically looking to DIY their health using over-the-counter medicines, supplies and

Based on the influx of research studies and position papers on social determinants of health flowing into my email box and Google Alerts, I can say we’re past the inflection point where SDoH is embraced by hospitals, professional societies, health plans and even a couple of pioneering pharma companies. PwC published a well-researched global-reaching report this week appropriately titled, Action required: The urgency of addressing social determinants of health. The “wheel of determinants” illustrates potential partners for collaborating in communities to address SDoH factors. The collaborators include governments, health care providers, payors, life science and pharma, tech and telecomms, policy

Over the past couple of weeks, Walmart is demonstrating its growing commitment to and leadership in healthcare and public health. The company’s announcement this week of pulling products that can be used in military-style weapons from its Outdoor Sports/Shooting department is a major move for public health that is something of a watershed that will impact well beyond the company’s inventory and stock price. This announcement will continue a trend among some thoughtful business leaders, like CEO Edward Stack of Dick’s Sporting Goods, banning gun sales from the retailer’s 125 stores in March 2019, who have begun to listen to

There are many definitions of the word, “labor.” Oxford Dictionary provides context for the definition as follows: To work, as in especially hard physical work To make great effort (as in, “laboring from dawn to dusk”) To have difficulty in doing something despite working hard. For this third point, Oxford offers these synonyms: “strive, struggle, endeavor, try hard, do one’s best, do all one can, go all out, fight, push, be at pains, put oneself out.” And finally, one fourth contextual point: “A labor of love.” That is indeed the perfect framing this Labor Day week for my welcome to

August 8 is National CBD Day. Who knew? Well, now you do, and I’m going to explain how this three-letter-acronym is rolling into the retail health landscape, opportunities, risks, and other issues I like to cover when forecasting the future of a new-new thing in health/care. “CBD” stands for cannabidiol, which is a derivative of cannabis, marijuana and hemp plants. CBD is the non-psychoactive compound derived from cannabis plants. CBD is being fast-adopted by consumers in retail and regulated shopping channels. One in seven Americans (14%) use CBD products, according to Gallup‘s new well-being research. One-third of U.S. consumers weren’t

When you think “J.D. Power,” your mind probably imagines reviews of automotive performance, retail shopping experiences, or perhaps even health insurance plan customer service. Expanding its report-card role in the health ecosystem. J.D. Power has undertaken a survey on consumer satisfaction with 31 telehealth providers across 15 measures, which will be published in November 2019. In advance of the full report, the organization released a summary on telehealth access and satisfaction, which I’ll discuss in this post. I’ll also weave in the latest insights from the ATA 2019 State of the States report updating legislative/regulatory telemedicine activity at the U.S.

Of the $401 billion that will flow through retailers for consumer technology products, many of the fastest-emerging categories will play a role as platforms for health and medical care at home and in wearable tech. This is my tea-leaf read from reviewing the projections in the report, U.S. Consumer Technology Sales and Forecasts, July 2019, from the Consumer Technology Association (CTA). [CTA is annual convener of CES, the world’s largest consumer electronics meet-up.] Along with artificial intelligence (AI) and fast 5G networking, the forecast also quantifies growth prospects for smart speakers, home robots, wireless earbuds, smartwatches. and in-vehicle technology —

Today is July 15, and my email in-box is flooded with all flavors of Amazon Prime’d stories in newsletters and product info from ecommerce sites — even those outside of Amazon from beauty retailers, electronics channels, and grocery stores. So I ask on what will probably be among the top ecommerce revenue generating days of all time: “What could health care look like when Amazon Prime’d?” I ask and answer this in my book, HealthConsuming, as chapter 3. For context, this chapter follows two that explain how patients in the U.S. have been morphing into health consumers based on how health

By Susannah Fox, Jane Sarasohn-Kahn and Lisa Suennen I’ve lived long enough to have learned The closer you get to the fire the more you get burned But that won’t happen to us Cause it’s always been a matter of trust           A Matter of Trust, by Billy Joel If you’re in health care and don’t live under a rock, you have probably heard that United Health Group (UHG) has acquired PatientsLikeMe (PLM).  After the announcement, there was a lot of sound and fury, some of which signified nothing, as the saying goes, and some which signified a lot.

“Health is now everyone’s business,” Shaheed Peera, Executive Creative Director of Publicis LifeBrands, said this week at the 2019 Cannes Lions awards. Shaheed also led the Health & Wellness jury at Cannes Lions 2019, the mission of which is to, in the words of the award’s portal, “celebrate creativity for personal wellbeing.” The Grand Prix Lions award for Health & Wellness went to IKEA for the company’s ThisAbles campaign. ThisAbles is a project pioneered by IKEA’s team in Israel, looking to improve everyday living for people with special needs through  well-designed IKEA products. IKEA collaborated with non-profit organizations to develop

Most U.S. healthcare providers are spending more time, effort and capital with an eye to engaging with patients-as-consumers, a trend quantified in the report, the 2019 State of Consumerism in Healthcare: The Bar is Rising from Kaufman Hall, summarizing results from this year’s healthcare consumerism index survey conducted among about 200 healthcare providers. “Legacy organizations will need premier-level consumer capabilities to compete in today’s increasingly consumer-centric environment,” Kaufman Hall recommends. Providers identified the key capability gaps for consumer-centric care as improving the consumer experience, offering a variety of facility-based access points, utilizing digital tools for health engagement, providing price transparency,

Health care is the top issue facing the U.S. today, one in three Americans says, with another one-fourth pointing to the economy. Together, health care + the economy rank the top issues for 62% of Americans. Health care and the economy are, in fact, intimately tied in every American’s personal household economy I assert in my book, HealthConsuming: From Health Consumer to Health Citizen. This poll from RealClear Politics, conducted in late April/early May 2019, makes my point that the patient is the consumer and, facing deductibles and more financial exposure to footing the medical bill, the payor.   Fully

With lower expectations of and satisfaction with health care, Millennials in America seek three things: available, accessible, and affordable services, research from the Transamerica Center for Health Studies has found. Far and away the top reason for not obtaining health insurance in 2018 was that it was simply too expensive, cited by 60% of Millennials. Following that, 26% of Millennials noted that paying the tax penalty plus personal medical expenses were, together, less expensive than available health options. While Millennials were least likely to visit a doctor’s office in the past year, they had the most likelihood of making a

There’s no denying the growth of telehealth, virtual visits, remote health monitoring and mHealth apps in the healthcare landscape. But these growing technologies don’t replace the role of real estate in health, wellness and medical care. Health care is a growing force in retail real estate, according to the ICSC, the acronym for the International Council of Shopping Centers, which has been spending time analyzing, in their words, “what landlords should know in eyeing tenants from a $3.5 trillion industry.” Beyond the obvious retail clinic segment, the ICSC points out a key driving growth lever for its stakeholders, recognizing that,

The 2019 Edelman Trust Barometer measured the biggest gap in trust for the healthcare industry between the U.S. “informed public” and the mass population. Fewer American women, too, trust the healthcare industry than men do. “This inequality of trust may be reflective of the mass population continuing to feel left behind as compared to others, even as they recognize the advances that are being made that could benefit them. Given tone and tenor of the day, and particularly among mass population, healthcare may continue to see increasing demands for change and regulation,” Susan Isenberg, Edelman’s head of healthcare, notes in

Pharmaceutical company executives are testifying in the U.S. Congress this week on the topic of prescription drug costs. One of those medicines, insulin, cost a patient $5,705 for a year’s supply in 2016, double what it cost in 2012, according to the Health Care Cost Institute. Know that one of these insulin products, Lilly’s Humalog,  came onto the market in 1996. In typical markets, as products mature and get mass adoption, prices fall. Not so insulin, one of the many cost components in caring for diabetes. But then prescription drug pricing doesn’t conform with how typical markets work in theory.

The vision/optical industry is one piece of the health/care ecosystem, but the segment has not been as directly impacted by patients’ new consumer muscles until just about now. It feels like the vision industry is at an inflection point at this moment, I intuited during yesterday’s convening of Decoding the Consumer: The new science of customer behavior, the theme of the 13th annual global leadership summit hosted by Vision Monday, a program of Jobson Medical Information which is part of the WebMD family. I was grateful to have an opportunity to share my views with attendees on the vision patient as

Today, the number of searches on Google using the phrase “self-care” reached a high, shown in the line graph I created on Google Trends and marked up in red. A Google search overall yielded over 2 billion results. I started this search when the Great Recession began in the U.S. in December 2007, and tracked “self-care” searches to today, 15 March 2019. I ran this little test because I’m speaking on Monday 18 March at the annual meeting of the Consumer Healthcare Products Association. CHPA was founded in 1881 as the “Proprietary Association.” In 1989, over 100 years later, the

There’s little Americans, by political party, agree upon in 2019. One of the only issues bringing people together in the U.S. is prescription drug prices — that they’re too high, that the Federal government should negotiate to lower costs for Medicare enrollees, and that out-of-pocket costs for drugs should be limited. The Kaiser Family Foundation has been tracking this topic for a few years, and this month, their March 2019 Health Tracking Poll shows vast majorities of Democrats, Independents and Republicans all share these sentiments. It’s not that patients who take prescription drugs don’t appreciate them – most (58%) say medicines

Across generations, from younger to older patients, cost, transparency and convenience drive consumer satisfaction, Accenture’s latest health consumer survey found. I had the opportunity to brainstorm the study’s findings in real-time on the day of survey launch, 12 February, with Dr. Kaveh Safavi, Brian Kalis, and Jenn Francis at HIMSS19. Our starting point was the tipping-point statistic that over 50% of people in the U.S. have chosen to use a non-traditional health care setting. Those non-traditional sites of care include walk-in and retail clinics, outpatient surgery centers, virtual health (whether on the phone, on video or via mobile apps), on-demand services,

Ten years ago, two brothers, physicians both, started up a telemedicine company called American Well. They launched their service first in Hawaii, where long distances and remote island living challenged the supply and demand sides of health care providers and patients alike. A decade later, I sat down for a “what’s new?” chat with Roy Schoenberg, American Well President and CEO. In full  transparency,  I enjoy and appreciate the opportunity to meet with Roy (or very occasionally Ido, the co-founding brother-other-half) every year at HIMSS and sometimes at CES. In our face-to-face brainstorm this week, we covered a wide range

Talk to me, patients are demanding in unison. Most health consumers expect providers to communicate about routine health care and prevention; this is especially true among those patients trying to manage chronic conditions we learn from 10 Ways to Fulfill Patients’ Communication Wish List, a report based on a consumer survey from West, the communications and network infrastructure company. Four in five patients say that talking to “me” means they want personalized recommendations to their unique needs – but only one-third of patients say they’re getting that level of service from their healthcare providers. Most health consumers expect providers to communicate about

For the past two holiday shopping seasons in 2017 and 2018, I’d noticed pre-print ads in my local Sunday newspaper from Kohl’s, the value-priced retailer, featuring wearable technology for health. There were devices branded Fitbit on the front page of Black Friday’s 2018 ad, shown here, with other tech brands promoted inside the pages. These ads were bundled in my newspaper along with ones from Best Buy, Target, Walmart, and other retailers featuring the same or similar wearable health-tech. This week, Kohl’s announced a collaboration with WW, the newly-rebranded Weight Watchers, for the retailer to bring a WW “salon” space

This is not a watch. Well, not just a watch. It can track heart rate. And it’s not even pink. Well, rose gold, perhaps. One of the benefits about being a woman attending CES is that there are no lines in the loos. The men’s rooms, however, are, shall we say, over-subscribed due to the big disparity between the number of male attendees versus females. Clearly, women are under-represented in technology companies at all levels, as the ladies’ room observation and many other more statistical reports recognize. But I’ve good news to report on the product front about women-focused consumer

I had the pleasure once again of attending Shelly Palmer’s annual kick-off breakfast where he level-sets our expectations for CES two hours before the tech halls open. Shelly is a consumer tech expert and leads the Palmer Group; comments on Fox 5 in NYC, CNN, and CNBC; writes a weekly column in Advertising Age; composes music; and he’s a Renaissance Man who’s a generous sharer of knowledge with a great sense of humor and humanity. Shelly is one of my trusted touchpoints for all-things-consumer-tech. His message at the start of #CES2019: this year, the show is about connectivity and partnership.

If I’m going to spend a week someplace, it usually has to be Italy. So next week in Las Vegas, I’ll deal with that bias by staying at the Venetian Hotel for the entire week to cover all-things-health at CES 2019, the annual convening of electronics retailers and enthusiasts. Most of the 180,000+ folks come to Vegas from over 150 countries to kick the proverbial tires on TVs, autos, games, virtual reality, 3-D printing, drones, and other shiny new things. For me, for the past eight years, CES means consumer-facing health in a person’s hands, on her phone, and increasingly

For the first time, we can take a clinically accurate blood pressure measurement from our wrist — welcome to the first of its kind wrist-worn blood pressure monitor, HeartGuide, brought to market by Omron.           I know this journey has been a long, patient one, as I came to know Ranndy Kellogg, Omron’s President and CEO, several years ago at CES. Back in 2017, I spoke with Ranndy about the vision for BP measurement for Everyday People that would be a streamlined, simple consumer experience that the traditional armband and pump didn’t offer. I wrote about

From culture to travel, food and drink to retail and beauty, health will be baked into consumer goods and experiences in 2019. Welcome to The Future 100: 2019 from The Innovation Group at JWT. In the 100 emerging trends across ten categories, the future is clearly health-driven, according to the tea-leaf readers at JWT.a Health is all over, Culture Tech and innovation Travel and hospitality Brands and marketing Food and drink Beauty Retail Luxury Health (as a category itself) Lifestyle. I’ve mined this report in previous years – you can review my findings from the 2017 report here in the Health

  American consumers are now viewing their phones an average of 52 times daily, with 39 percent of consumers believing they use their smartphones too much. In fact, 60 percent of 18 to 34-year-olds admit to smartphone overuse, the highest level of any age group. However, 63 percent of the respondents reported trying to limit their smartphone usage, roughly half succeeding in cutting back. Smartphones also are helping blur the lines between work and leisure with 70 percent of respondents using personal smartphones at least occasionally for after-hours work. Furthermore, voice technologies are “making noise,” according to Deloitte in A New Era

Most patients wish their doctors would have a conversation with them about non-medical issues. The Doctor-Patient Conversation, a survey conducted for the Samueli Foundation by the Harris Poll, examined how patients feel about their health, healthcare, and relationships with physicians. The Samueli Institute, has several missions including integrative health with a focuses on evidence-based practices for healing, wellbeing and resilience. Patients are keen to learn about non-medication alternatives, like food-as-medicine, meditation, and acupuncture. But most doctors base their conversations with patients on purely medical options like lab test results and surgical procedures. The top issues doctors discuss with patients are

Eat food, not too much, mostly plants, Michael Pollan advised us on the cover of his breakthrough book on nutrition in America, In Defense of Food.  In Las Vegas, it’s not too easy to live and eat  according to Pollan’s Food Rules. We’re at a fork in the road when it comes to food, retail grocery shopping, and health, which is an intersection I’m increasingly working in these days. The Groceryshop conference is further informing my understanding of the landscape of the technology that’s enabling the consumer’s ability to curate, purchase, and receive the food they want to satisfy hunger and

There’s a shortage of medical providers in the United Kingdom, a nation where healthcare is guaranteed to all Britons via the most beloved institution in the nation: The National Health Service. The NHS celebrated its 70th anniversary in July this year. The NHS “supply shortage” is a result of financial cuts to both social care and public health. These have negatively impacted older people and care for people at home in Great Britain. This article in the BMJ published earlier this year called for increasing these investments to ensure further erosion of population and public health outcomes, and to prevent

Today, October 16, is World Food Day. At Health Populi and THINK-Health, we celebrate the birthday of the Food and Agriculture Organization (FAO), allied with the United Nations. FAO was founded to address malnutrition and bolster a sustainable, healthy food supply for people. World Food Day 2018 has four objectives: Don’t waste food Produce more food with fewer resources Advocate for #ZeroHunger by 2030, and, Adopt a healthier, more sustainable diet. All four of these pillars play a role in health, but I’ll focus today on the fourth: the role of food as a major social determinant of health. Hunger

California’s Governor Jerry Brown signed into law a net neutrality bill this weekend. Gov. Brown’s proverbial swipe of the pen accomplished two things: he went back to the Obama-era approach to ensure that internet service providers treat all users of the internet equally; and, he prompted the Department of Justice, representing the Trump Administration’s Federal Communications Commission (FCC), to launch a lawsuit. California, home to start-ups, mature tech platform companies (like Apple, Facebook and Google), and countless digital health developers, is in a particularly strategic place to fight the FCC and, now, the Department of Justice. Nearly two dozen other states

Most consumers look to every industry sector to help them engage with their health. And those companies include the insurance industry and financial services firms, we found in the 2010 Edelman Health Engagement Barometer. John Hancock, which covers about 10 million consumers across a range of products, is changing their business model for life insurance. Here’s the press release, titled, “John Hancock Leaves Traditional Life Insurance Model Behind to Incentivize Longer, Healthier Lives.” “We fundamentally believe life insurers should care about how long and well their customers live. With this decision, we are proud to become the only U.S. life insurance

Consumers who have long purchased over-the-counter medicines, anti-dandruff shampoo, whitening toothpaste, and cosmetics-with-benefits at food, drug and mass merchant retailers are switching to other places to shop for health, new data from AT Kearney and GMDC have found. The two organizations have collaborated to launch a new  benchmarking study into health-beauty-wellness (HBW) sales, launched this weekend at the GMDC HBW Conference in Orlando. Overall, 2017 to 2018 year-on-year, HBW sales were flat-to-no growth, notwithstanding the consumer and influencer buzz around the categories.       This study uncovered some very important trends underneath the macro numbers that tell a story

Patients are the new healthcare payors, and as such, taking on the role of health consumers. In fact, health and wellness consumers have existed since a person purchased the first toothpaste, aspirin, heating pad, and moisturizing cream at retail. Or consulted with their neighborhood herbalista, homeopathic practitioner, therapeutic masseuse, or skin aesthetician. Today, the health and wellness consumer can DIY all of these things at home through a huge array of products available in pharmacies, supermarkets, Big Box stores, cosmetic superstores, convenience and dollar stores, and other retail channels – increasingly, online (THINK, of course, of Amazon — more on

Most Americans have been surprised by a medical bill, a NORC AmeriSpeak survey found. Who’s responsible? Nearly all Americans (86% net responsible) first blame health insurance companies, followed by hospitals (82%). Fewer U.S. patients blamed doctors and pharmacies, although a majority of consumers still put responsibility for surprise healthcare bills on them (71% and 64% net). Most of the surprise bills were for charges associated with a physician’s service or lab test. Most surprise charges were not due to the service being excluded from a health plans provider network. The poll was conducted among 1,002 U.S. adults 18 and over

In the U.S., the growing prevalence of multi-morbidity is contributing to increased mortality and healthcare cost growth in America. Underlying this clinical and economic phenomenon is obesity, which primary care doctors are challenged to deal with as a chronic condition along with typically co-occurring comorbidities of hypertension, diabetes, and hyperlipidemia. The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014, published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. The authors, affiliated with the West Virginia University Department of Family Medicine, call out that obesity (the pink-red line)

With the acquisition of GreatCall, a mature player in the aging-tech space, Best Buy is doubling down on consumer health technology@retail. This week at Best Buy. the electronics retailer,  it’s out with CDs and in with technology for aging at home. The company announced that it would buy GreatCall for $800 million. A snippet from the announcement from Best Buy’s press release is shown in the first diagram, noting that GreatCall’s membership is approaching 1 million subscribers who use mobile phones and connected devices, “providing peace of mind to their loved ones.” Beyond the obvious “falling and I can’t get

All sectors who are stakeholders in the healthcare ecosystem aren’t created equal, Accenture explains in their report, Healthcare’s future winners and losers. Observing the influx of new flavors of entrants like Amazon and Google, start-ups like Iora Health, Oscar and FetchMD, begs the question: how will legacy healthcare system players fare? Who will survive, and what will be the success factors that bolster long-term viability? To answer that question, Accenture points to three market trends that set “new rules” in healthcare: Blurred lines, which are the grey areas and adjacencies between technology, service, finance, and retail The middle of nowhere,

While Amazon and Google get lots of positive PR and media attention as major healthcare industry disruptors, don’t forget about two big “W’s,” Walgreens and Walmart, in the healthcare innovator mix. I recently read The Four in which Scott Galloway explains the dominance of Amazon, Apple, Google and Facebook in consumers’ everyday lives. These four tech-behemoths each have their particular designs on healthcare innovation, or disruption in the eyes of, say, Epic and Cerner working on health IT systems, or GE and IBM if you’ve been pioneers in health data or big-iron information technology. Then in the past week, the

If you live in one of nine U.S. states, your chances of having heart disease are greater than living in the 41 others. This geography-as-destiny for heart conditions is examined in The Burden of Cardiovascular Diseases Among US States, 1990-2016 published in JAMA Cardiology. Researchers analyzed data on cardiovascular disease mortality, nonfatal health outcomes, and risk factors by age, sex, and year from 1990 to 2016 for the U.S. population. The outcome used to measure health by state was cardiovascular disease disability-adjusted life-years, or DALYs (FYI, “DALYs” are a commonly used metric in health economics research).   Pennsylvania While overall cardiovascular