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Demystifying Medicine One Week at a Time

Category: preventive health (page 1 of 10)

Can your city become a Blue Zone?

 

Tulsa is on a roll. With recent announcements about the openings of Gathering Place and a new Amazon fulfillment center, good news abounds. This week we have another opportunity to keep it rolling.

On Tuesday and Wednesday, our city will host visitors from Blue Zones, who will be here to help determine whether our community has what it takes to become a Blue Zone city.

What are Blue Zones?

Explorer Dan Buettner traveled the world to find the places where people live the longest and healthiest. In these places, which he named Blue Zones, people routinely live to 100 years of age, while still active and engaged.

Buettner formed a company to share the knowledge and practices of Blue Zones, and these initiatives have spread across more than 40 U.S. cities in nine states.

Blue Zones projects are designed to unite our community behind a common goal: transforming environments so there are more ways to make healthy choices easier.

More places to walk and bike outdoors. More healthy foods. And more purpose. All of which leads to more years to enjoy it all.

The Blue Zones matrix is not a turnkey solution. Their experts work in a diverse array of communities and bring scaffolding upon which we can build our own programming. We Tulsans must lead the way on implementation and operation.

Buettner will provide the event’s keynote address in a public presentation 6 p.m. Tuesday at OU-Tulsa’s Perkins Auditorium at the Learning Center on the Schusterman Campus.

Wednesday there’s an event called “Wine @Five,” which celebrates the social health aspects of Blue Zone communities. In addition, you’ll have the opportunity to meet Blue Zones personnel and many of our community stakeholders, ask questions, and share ideas. That event will take place at 5 p.m. at TCC’s Center for Creativity.

RSVPs are encouraged but not required.

Both events are free and open to the public — you can learn more about them and RSVP at this website: go.bluezonesproject.com/tulsa.

We hear all the time about how dismal our health outcomes are in Oklahoma. More people smoke, are overweight, and suffer from diabetes, mental illness and cardiovascular diseases than national averages.

We are near the bottom in terms of life expectancy, health promoting behaviors and access to health care. Nationally, our model of health care has emphasized the dousing of fires (“rescue care”) rather than fire prevention.

When I talk to patients, I boil down prevention to a few simple precepts that are easy to say but harder to do. Regular practice turns them into healthy behaviors. They are:

  • Get enough sleep.
  • Move your body throughout the day.
  • Eat well — a healthy assortment of foods. Mostly plants, and not too much.
  • Interact socially. Isolation is not good for the body, soul or mind.
  • Take some time to reflect on what you are grateful for.

These behaviors are practiced in Blue Zones across the world. They are not unique to those areas, and they can be more easily achieved here in Tulsa.

If finding a way to make life healthier as a core value speaks to you, then come learn about Blue Zones.

In addition to the two public events I mentioned earlier, there will be several theme-based focus groups taking place throughout the region on June 27. You can learn more about these at go.bluezonesproject.com/tulsa.

This week’s Blue Zones visit to Tulsa did not happen by chance. Many partners have been involved in bringing the site visit to life — including Mayor G.T. Bynum’s Office, the Tulsa Regional Chamber and the Tulsa Health Department. Local businesses, nonprofits, foundations and educational institutions have contributed time, talent and money to bring Blue Zones to Tulsa.

Here’s hoping that Tulsans can live healthier and longer and keep our city on a roll.

Dr. John Henning Schumann is president of the University of Oklahoma — Tulsa.

 

In Medicine, Less is Often More

Dr. Rita Redberg at #Lown 2016

Dr. Rita Redberg at #Lown 2016

Fewer visits.

Fewer tests.

Less harm from what we find, and less harm from any subsequent treatments.

Less cost.

More engagement with your own health, and what you can do to make it great. You can do it yourself.

Reducing Harm in Health Care

Gary Cohen, Co-Founder and President Health Care Without Harm, photographed in Charlestown, Mass., Friday, Sept 18, 2015, at The Spaulding Rehabilitation Hospital, one of the first hospitals built embracing Cohen's advocacy of self-sustaining, environmentally responsible healthcare networks. (Credit: John D. & Catherine T. MacArthur Foundation)

credit: MacArthur Foundation

When we talk about harm in the world of health care, we’re usually referring to patients and the facilities in which we provide care. These are the ‘typical’ things we hope to avoid, not only because they are bad outcomes, but because they now carry the specter of financial penalties when they occur:

  • medication errors
  • wrong side surgeries
  • hospital mishaps, like falls
  • missing a diagnosis
  • hospital-acquired infections and those induced by medical hardware

But Gary Cohen of the advocacy coalition Health Care Without Harm takes a much broader view of the harms that health enterprises can cause. Founded in 1996, HCWH is now a multi-national coalition of health care enterprises, governmental and non-governmental agencies, and other advocacy groups.

Cohen and HCWH have had some amazing successes. In less than two decades, HCWH has been able to reduce the number of medical waste incinerators in the U.S from more than 5000 to fewer than 100. Why should we care? It turns out that burning medical waste pours tons of the harmful chemical dioxin into the environment.

Another example: The formerly ubiquitous mercury thermometer. They used to break all the time. Fun to play with the drops of mercury, but highly toxic. Neurotoxic, in fact. And when mercury gets in our water supply, the fatty fish we eat (salmon, swordfish, tuna, mackerel, even shark) slowly poison us — which is why pregnant women and children are advised to avoid eating fresh fish in more than minute quantities.

HCWH was able to make the case that there are technological alternatives to mercury thermometers — that work just as well and are much, much safer. And they’ve been successful. When’s the last time you saw or used a mercury thermometer?

For this tireless advocacy, which also includes making hospital food supplies safer and hospital buildings themselves green and super safe (think natural disasters), Cohen was awarded a MacArthur Foundation Fellowship (think ‘genius grant’) last Fall.

You can hear an interview with Cohen here — give a listen and broaden your perspective on reducing harm in health care.

A New Hero

I have a new hero. Her name is Mona Hanna-Attisha, MD, MPH.

monahannaattishaDr. Hanna-Attisha is a pediatrician in Flint, Michigan. She grew up in a suburb of Detroit. She graduated from the University of Michigan before attending medical school at Michigan State University. During her clinical years (the 3rd and 4th years of medical school), she spent many months at Hurley Medical Center in Flint, which serves as a clinical training site for MSU medical students (far from the flagship campus — something I can relate to).

As you may know from recent news, Flint has had some problems — especially due to an overabundance of lead in its drinking water.

For cost-saving reasons, the city of Flint switched the source of its drinking water from the Detroit system to the Flint River in April 2014. Almost immediately residents of the town began noticing the water looked, smelled, and tasted different. It took nearly a year and half for both state and federal officials to acknowledge that there was too much lead in the Flint water — repeatedly questioning the evidence that it was so.

That’s where our new hero comes in.

Dr. Hanna-Attisha directs a pediatric residency training program at Hurley. There are 190 pediatric residency training programs in the United States, training in total about 2600 pediatricians every year.

I can relate to this part of her job — my most recent role was directing an Internal Medicine residency. Though the medical issues are different (kids vs. adults), residency program directors have three essential jobs: recruiting medical school graduates, charting the learning curriculum, and making sure the program stays accredited.

Program Directors become role models for trainees. We try to inspire and motivate residents, offering career and life advice during what is a demanding three year training curriclum.

On top of clearly being good at this role for her residents (7 per class for a total of 20 or so residents), Dr. Hanna-Attisha uses her MPH training to do science — in this particular case epidemiology.

She combed through records at her medical center and discovered that lead levels measured in children’s blood in Flint (as part of routine pediatric care) had on average nearly doubled since the time of the water source switch. Though her claims were at first disputed by state officials, Dr. Hanna-Attisha kept at it, talking to parents, hospital leadership, and advocating with state and federal officials.

In the end, the simple elegance of her team’s science got the message across. The story has now received national attention, including the declaration of a federally-recognized ‘State of Emergency’ in Flint over its water supply.

I was researching Dr. Hanna-Attisha, and came across this TED-like talk she gave at a Michigan State College of Medicine event in 2014. It predates the Flint water story, but it shows her to be a dedicated public servant — not only committed to her trainees and her patients, but beyond that to questioning the very core of what makes people unhealthy: the social determinants of health.

Take a look and let me know what you think.

Timing is Everything

IUDs & Implant

Quick: Which US state has the highest rate of unintended pregnancy?

I’ll reveal below, but I learned the answer and several other surprising facts in an interview with Mark Edwards, the co-founder of Upstream USA, a non-profit training organization that provides technical assistance to health enterprises (medical practices, clinics, public health departments) in the use of long-acting, reversible contraceptives (known in the trade as LARC).

LARC consists of two options: IUDs (intrauterine devices) and implants — which are small, match-sized, plastic rods that deliver a slow, steady dose of hormone to prevent pregnancy. They are planted in the upper arm of women to provide another form of hassle-free contraception.

Both of these methods can be discontinued at any time, at which point fertility returns — faster, I’m told, than in the case of oral contraceptives.

Here’s a fact that surprised me about oral contraceptives (aka “The Pill”): Though when taken reliably their ‘success rate’ as a means of preventing unwanted pregnancy is considered to be 99%, over a 10 year use period, due to the challenging nature of remembering to take a daily pill, it’s likely that 61% of those taking the pill exclusively for birth control will become pregnant. Most definitely not the intended outcome. (Source: here.)

Big picture: every year in the US, there are about 6.6 million pregnancies. Of those, 3.4 million, or slightly more than half, are accidental: either altogether unwanted or ‘significantly mistimed’ — what we in the health care business describe as a pregnancy occurring 2 or more years before desired. The vast majority of these accidental pregnancies occur in women in their 20s (though teen pregnancy is a concern, only 20% of unplanned pregnancies are in teens, and the vast majority of those are in women 18-19 years old. In fact, the teen pregnancy rate has fallen significantly in the last 25 years).

That’s why, regardless of your politics, offering LARC to any woman of childbearing age is crucial. At the very first visit. As a primary care doc myself, I know that ‘family planning’ often falls down the list of concerns for patients that I see because there are so many other issues people wish to bring up in our short office visits. Thus, opportunities to provide women with LARC often fall through the cracks.

Upstream USA’s methodology includes technical assistance: training staff up to ask every woman that comes in a simple question: “Do you intend to get pregnant in the next year?”

If ‘yes,’ let’s get her into preconception care (folic acid, multivitamins, etc.). If ‘no,’ offer LARC right then and there. And the provider (doctor, nurse practitioner, or physician assistant) is trained up to put in an IUD or implant on the spot. No waiting until next time.

Why is this so important? Women with unplanned pregnancies are at greater risk for staying or falling into poverty. Their opportunity to advance in their education is diminished. Children should be brought into the world wanted — with parents that are prepared — with the maturity and resources to succeed.

It’s a fundamental choice for a woman to decide if and when she wants to have children. Of course, fewer unplanned pregnancies also means less need for abortion.

So what Upstream USA is offering is win-win-win. It’s bipartisan — a rare area that people on all sides of the political spectrum can agree upon. Upstream USA’s first big success was in none other than Texas. The organization also has partnerships in a number of other Red and Blue states.

The state with the highest rate of unplanned pregnancy? Surprisingly, Delaware. Upstream USA is there, too. And going big — across the whole state.

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