Saturday, April 7, 2018

It's World Health Day

April 7th is World Health Day.
This is the 70th anniversary of the World Health Organization (WHO)

 The theme of World Health Day 2018 is: Universal health coverage (UHC): everyone, everywhere. The slogan is “Health for All”.

 Key messages for World Health Day 2018

Universal health coverage is about ensuring all people can get quality health services, where and when they need them, without suffering financial hardship.

No one should have to choose between good health and other life necessities.

UHC is key to people’s and nations’ health and well-being.

UHC is feasible. Some countries have made great progress. Their challenge is to maintain coverage to meet people’s expectations.

All countries will approach UHC in different ways: there is no one size fits all. But every country can do something to advance UHC.

Making health services truly universal requires a shift from designing health systems around diseases and institutions towards health services designed around and for people.

Everyone can play a part in the path to UHC, by taking part in a UHC conversation.

Too many people are currently missing out on health coverage

“Universal” in UHC means “for all”, without discrimination, leaving no one behind.

Everyone everywhere has a right to benefit from health services they need without falling into poverty when using them.

Here are some facts and figures about the state of UHC today:

At least half of the world’s people is currently unable to obtain essential health services.

Almost 100 million people are being pushed into extreme poverty, forced to survive on just $1.90 or less a day, because they have to pay for health services out of their own pockets.

Over 800 million people (almost 12 percent of the world’s population) spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or other family member. They incur so-called “catastrophic expenditures”.

Incurring catastrophic expenses for health care is a global problem.

In richer countries in Europe, Latin America and parts of Asia, which have achieved high levels of access to health services, increasing numbers of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses.

What UHC is

UHC means that all people and communities receive the health services they need without suffering financial hardship.

UHC enables everyone to access the services that address the most important causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.

What UHC is not

UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis.

UHC is not only about ensuring a minimum package of health services, but also about ensuring a progressive expansion of coverage of health services and financial protection as more resources become available.

UHC is not only about medical treatment for individuals, but also includes services for whole populations such as public health campaigns – for example adding fluoride to water or controlling the breeding grounds of mosquitoes that carry viruses that can cause disease.

UHC is not just about health care and financing the health system of a country.

It encompasses all components of the health system: systems and healthcare providers that deliver health services to people, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms and governance and legislation.

© WHO 2018

Wednesday, September 6, 2017

Lifestyle Changes Can Reduce Dementia Risk, Study Says

Nine lifestyle changes can reduce dementia risk, study says

One in three cases of dementia could be prevented if more people looked after their brain health throughout life, according to an international study in the Lancet.

It lists nine key risk factors including lack of education, hearing loss, smoking and physical inactivity.

The study is being presented at the Alzheimer's Association International Conference in London.

By 2050, 131 million people could be living with dementia globally.
There are estimated to be 47 million people with the condition at the moment.

Nine factors that contribute to the risk of dementia

Mid-life hearing loss - responsible for 9% of the risk
Failing to complete secondary education - 8%
Smoking - 5%
Failing to seek early treatment for depression - 4%
Physical inactivity - 3%
Social isolation - 2%
High blood pressure - 2%
Obesity - 1%
Type 2 diabetes - 1%

These risk factors - which are described as potentially modifiable - add up to 35%. The other 65% of dementia risk is thought to be potentially non-modifiable.

Although dementia is diagnosed in later life, the brain changes usually begin to develop years before," said lead author Prof Gill Livingston, from University College London.

"Acting now will vastly improve life for people with dementia and their families and, in doing so, will transform the future of society."

The report, which combines the work of 24 international experts, says lifestyle factors can play a major role in increasing or reducing an individual's dementia risk.

It examines the benefits of building a "cognitive reserve", which means strengthening the brain's networks so it can continue to function in later life despite damage.

Eve Laird, from Dumfries, is worried about dementia because her mum is living with the condition.

She has decided to make some changes to her lifestyle.

"I'm terrible for eating processed foods and takeaways and I've really been trying to cut back on that.
"I definitely drink a lot more water than I used to - and I don't drink as much coffee now.
"I actually took part in the Edinburgh marathon. For that I joined the Dumfries running club - I go there once a week."
She says she felt so much better for the exercise, and for improving her diet.
"I felt a lot healthier and mentally sharper as well. It's something I'd really like to continue, but it is hard to stay on track."
"I just think the small changes can make such a big difference."

Failure to complete secondary education was a major risk factor, and the authors suggest that individuals who continue to learn throughout life are likely to build additional brain reserves.

Another major risk factor is hearing loss in middle age - the researchers say this can deny people a cognitively rich environment and lead to social isolation and depression, which are among other potentially modifiable risk factors for dementia.

Another key message from the report is that what is good for the heart is good for the brain.

'Positive changes'
Not smoking,
doing exercise,
keeping a healthy weight,
treating high blood pressure and diabetes can all reduce the risk of dementia, as well as cardiovascular disease, and cancer.

The researchers say they did not have enough data to include dietary factors or alcohol in their calculations but believe both could be important.

Dr Doug Brown, director of research at Alzheimer's Society, said:

"Though it's not inevitable, dementia is currently set to be the 21st Century's biggest killer. We all need to be aware of the risks and start making positive lifestyle changes."

Dr David Reynolds, chief scientific officer at Alzheimer's Research UK, said: "Alongside prevention research, we must continue to invest in research to find a life-changing treatment for people with this devastating condition."

Physician Well-being: A Critical Missing Link in Medical Education

Physician Well-being: A Critical Missing Link in Medical Education

At the Southern California Permanente Medical Group (SCPMG), the physician-led care delivery system that partners exclusively with Kaiser Foundation Health Plan and Hospitals in Southern California, we are committed to helping solve physician burnout and see this as a critical aspect of transforming health care in America.

Practicing medicine today is far more demanding and multifaceted than when I began my practice in 1984 as a family physician at Kaiser Permanente. 

Medicine has made remarkable progress in technology and outcomes, but advances have come with a price for physicians.

Doctors are experiencing greater stress due to a myriad of causes: Long hours, loss of autonomy, complex and often inefficient systems, and additional time-intensive responsibilities such as maintaining electronic medical records, diagnostic coding, regulatory compliance and administrative duties.

This stress is compounded by personal attributes of self-sacrifice, hyper-accountability, perfectionism, challenges with boundary setting, and equating asking for help as weakness. 

Altogether, this too often leads to poor work-life integration and burnout for physicians.

In their noble calling to take the best possible care of their patients, many physicians put their own well-being at risk.

Physician Burnout on the Rise

Physician burnout in the U.S. is rising at an alarming rate. A survey by the Mayo Clinic revealed that from 2011 to 2014, physicians experiencing at least one symptom of burnout rose from 46% to 54% – a much greater level than in other professions. Of those surveyed, 39% experienced depression, increasing the risk of suicide.  

At SCPMG, I have made physician wellness a key focus of our vision to help transform health and health care in America.

I began by asking our physicians how they viewed our culture of health. The initial results were not encouraging.

This led to my appointing a Physician Chief Wellness Officer. In four short years,

Dr. Dawn Clark has helped lead the creation of a robust physician wellness program that provides support, knowledge and tools to help physicians better manage their busy lives and embrace their own health and resilience.

Second Victim Syndrome (the burden providers feel after an adverse patient outcome) and peer-to-peer support groups have been formed and provide emotional support to colleagues.     

 However, this is just one part of the equation. Leaders in health care must take ownership for the creation of a wellness culture that supports physician health along with the design of efficient systems and workflows that maximize a physician's unique contributions to patient care.

Bureaucracy and inefficiency in care delivery systems must be addressed. 

Some of the systemic changes we’ve made since our program began include workflow redesigns that off-load clerical work from physicians, help physicians manage email volume through support staff, and train doctors on using our electronic medical records system with greater ease and efficiency.

We also have worked to increase availability of alternate and flexible schedules to better meet the needs of physician work-life integration. 

As a result of this work, a recent survey of our physician colleagues indicates significant improvements in how doctors view our wellness culture since the initial survey three years ago. Physician ratings of key workplace “culture of health” measures improved by a range of 11-23 percent. Although we are making progress, there is more work to be done.

For Many, Burnout Begins in Medical School

Part of the solution to achieving greater physician wellness and resilience lies in influencing the medical culture in America further upstream – in medical school. 

For physicians, asking for help when we are stressed is counter to what we have been taught, consciously or otherwise: That to be a good physician, we must be superhuman, self-sacrificing care providers, able to work long hours while putting our patients’ needs before our own.

A study published in Academic Medicine in 2014 concluded that students entering medical school have better mental health indicators than age-similar college graduates in the general population.

However, by graduation, the mental health, resilience, and optimism of medical students have declined.

Anyone who has attended medical school understands some of the contributing factors: Long hours spent studying volumes of information; the unrealistic pressure to be perfect; the emotional impact of dealing with death and dying; a fear to admit that one may need help with mental health issues; inadequate boundary setting; and feelings of isolation.

Recognizing and addressing causes of burnout can potentially alleviate depression and prevent suicide, not only in medical school but throughout one’s career.

To do so will require providing students with emotional resilience tools that they can use throughout medical school and beyond, making it safe to talk about their struggles and ensuring that effective mental health resources are available when needed.

A Different Kind of Medical School

Kaiser Permanente is planning a national school of medicine in Pasadena, California with a curriculum that will incorporate new ways of training doctors.

It is our intention to establish a learning environment and curriculum that supports, teaches and models well-being and resilience – skills and techniques that students can employ throughout their careers as physicians.

Our physician-led school will embrace a holistic approach not only toward curriculum development and mentoring, but in helping students achieve resilience and a healthy lifestyle in body, mind and spirit.

We have designed the new facility to include space for socialization, a rooftop meditation area, a yoga garden and a fitness center, so the school will be a convenient place to practice what we teach.

A demonstration kitchen on campus will be a place for students to learn about nutrition, and how to prepare their own healthy meals.

The curriculum will emphasize the importance of sleep and encourage students to find a personal exercise regimen to promote fitness and reduce stress. They will learn that it's okay to ask for help and be connected to mental health resources. 

Connecting students to their purpose will also be key.

As a school that reflects Kaiser Permanente’s values of diversity, inclusion, health equity and community health, our students will be connected to the meaning of what they do through aligned curriculum and experience, engaging with patients and the communities we serve. 

We will teach students change management and how to work effectively within systems of care -- to be both leader and effective team member -- so as physicians they can be agents of change in improving the care delivery systems in which they practice.

Most importantly, our intent is to create a culture that declares that physician wellness matters. In fact, physician wellness is essential if we are to have healthy patients and an effective health care system in America.

Burnout and poor physician wellness can negatively affect quality of care, patient satisfaction, medical errors and malpractice risk, as well as turnover of staff and early physician retirement. 

We need strong and resilient physicians to lead the needed transformation of health and health care in our country.

Finding Solutions

This past April, The Kaiser Permanente School of Medicine invited medical students, medical educators and leaders from across the country to brainstorm about how to shift the paradigm of medical education towards supporting and sustaining greater levels of well-being and resilience for students.

The convening began with a tour and dinner at the Association of American Medical Colleges (AAMC). 

Several members of the AAMC attended and participated in the conference, including the president and CEO of the AAMC, Darrell G. Kirch, MD.

I was honored to give the keynote address and participate in the ensuing discussions. I began my talk by asking the audience a somber question: “How many of you were aware of a fellow student committing suicide in medical school?” Sadly, about half the room, including me, raised our hands.

The mood became more optimistic throughout our conference as we brainstormed a list of root causes and declared a commitment to find solutions for mitigating burnout in medical school and beyond. 

We ended the day with a sense of hope and renewed purpose, and yet we were aware that this is just the beginning.

I invite all who see themselves as stakeholders in creating both the culture and structure that fosters greater physician resilience and well-being to join our continuing conversation to solve for physician burnout in our country.

Dr. Ed Ellison believes Permanente Medicine and Kaiser Permanente’s coordinated, integrated model of high-quality, affordable care provides an answer to health, health care and physician wellness in America. In his effort to achieve wellness, Dr. Ellison enjoys time with family, favors a plant-based diet, tries to get enough sleep, and always takes the stairs.

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