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Diet Soda – A Correlation to Stroke and Dementia

Posted on: 05.09.17 By: David P. Lind

Diet Soda - Stroke & Dementia CorrelationEvery day we learn of new study results that admonish us to consume more (or avoid) foods and beverages to keep us both safe and healthy. Some reports conflict with one another, causing us to become even more confused about our daily dietary decisions.

For a number of years, sugar-sweetened soda had been associated with obesity, diabetes, poorer memory and small overall brain volumes. Over time, sugary soda was no longer the ‘beverage of choice’ for some. It was substituted for a seemingly more palatable option – diet soda, a sugar-free, calorie-free carbonated water with artificial-sweetened versions.

However, a 2013 National Center for Biotechnology Information (NCBI) study revealed that both sugar-sweetened and artificially sweetened beverages were linked to an increased risk of developing Type 2 Diabetes. Another study, after adjusting for common factors that contribute to weight gain such as dieting, exercising change or diabetes status, showed that those who drank artificially-sweetened drinks have a 47 percent higher increase in Body Mass Index than those who did not.

A study released in the May journal of Stroke concluded that “artificially-sweetened soft drink consumption was associated with a higher risk of stroke and dementia.” It found that those who drank at least one artificially-sweetened drink a day were 2.96 times as likely to have an ischemic stroke and 2.89 times as likely to be diagnosed with dementia due to Alzheimer’s Disease. The research, however, emphasized that it did not show causation to these diseases, only a correlation. This study’s takeaway is this:  Diet sodas may not necessarily be a healthier alternative to sugar-sweetened beverages.

Iowa Healthiest State Initiative

I serve as a committee member on the Iowa Healthiest State Initiative (HSI), a statewide program whose mission is “To improve the physical, social and emotional well-being of Iowans.” As the name suggests, the goal of HSI is to ultimately “become the healthiest state in the nation.” Our workgroup is currently assessing many different healthy measurement metrics  – including dietary behaviors – that will gauge the progress Iowans make when living active and healthy lifestyles. One key dietary measurement objective that we will likely pursue is decreasing the number of Iowans who consume sugar-sweetened beverages on a daily basis. As with all objectives, the idea is not to have prescriptive “Do’s” and “Don’ts” for Iowans. The goal is to gently nudge behaviors that will encourage positive outcomes for the individual’s physical and emotional well-being.

This most recent study provides yet another reason to temper our thirst for sugar- and artificially-sweetened beverages. Other healthier options to these sugar-sweetened beverages? According to The Nutrition Source from the Harvard T.H. Chan School of Public Health, drink more water, tea or coffee (with little or no sugar), limit milk and dairy products (1-2 servings/day) and just one small glass of juice each day. Again, these are merely suggestions.

More about the Healthiest State Initiative, version 2.0, in future blogs!

To stay abreast of healthcare-related issues, we invite you to subscribe to this blog.

Time to Move Upstream and ‘Invest’ in our Health

Posted on: 11.21.16 By: David P. Lind

Time to Move Upstream and 'Invest' in our Health

Authors:  David P. Lind and Yogesh Shah, MD, MPH

Employer-sponsored health premiums in Iowa have increased 215 percent since 1999. This growth, however, appears tame when compared to health insurance plans sold in the individual market. We’ve grown so accustomed to rising health costs that it has become the ‘new normal’ with no apparent silver bullet in sight to remedy the core problems. Healthcare costs continue to outpace general inflation, typically by two-to-three fold. We live with constant anxiety about paying more for our healthcare – whether through taxes, premiums, deductibles and/or other out-of-pocket expenditures.

With the advent of a new Trump administration geared to repeal many Obamacare components, all sorts of health insurance “solutions” will be debated. Ideas to make coverage more competitive include selling policies across state lines, pushing for health savings accounts, and relying on other tax incentives to perform magic. However well-intentioned, belief that the insurance component will somehow fix our cost problem is wishful thinking.

The major source of this problem is our unhealthy population. “Upstream” environmental factors greatly impact our “downstream” health. for all of us. Upstream factors are many – primarily poor nutrition, inadequate housing and education, and low incomes – all considered to be social determinants of our health.

To meaningfully address healthcare costs in Iowa and nationally, we must be willing to consider new approaches and develop a mindset that transcends party politics. This may sound counterintuitive, but to reign in ever-increasing healthcare costs and enhance better population health, we should explore new solutions ‘upstream’ to invest in our collective health and well-being. This is not about implementing ‘socialized medicine.’ It’s about using our limited resources more wisely on key determinants of overall health that can ultimately improve health and control healthcare costs.

Healthcare Spending

In 2014, we spent 17.5 percent of our economy on healthcare, reaching $3 trillion annually. By comparison, in 1960, we spent only five percent on healthcare. One disturbing estimate by the Institute of Medicine shows about one-third of our healthcare spending – or $1 trillion – is widely considered wasted spending, money that can be better invested elsewhere.

Should healthcare costs dominate such a large segment of our economy? If so, shouldn’t we be healthier than other nations based on what we spend? On a per capita basis, the U.S. performs poorly on many key health indicators. For example, our country has lower birth weight, higher maternal and infant mortality, as well as higher incidents of injuries, obesity, diabetes, heart disease, chronic lung disease, disability rates, mental illness and, surprisingly, shorter life expectancy. In addition, we have more drug-related deaths than other industrialized countries.

With these in mind, one would think that most comparable countries must be outspending the U.S. on healthcare services. The facts are quite the opposite. In 2009, our country spent 16.3 percent of its gross domestic product (GDP) on healthcare, about six percentage points higher than the average 10.3 percent spent by 10 other industrialized countries. Yet, our growing appetite for more healthcare spending results in poorer health outcomes. This is both puzzling and frustrating – for policymakers, taxpayers, employers and their employees.

Time to Move Upstream and 'Invest' in our Health - Aggregate Health Care Spending by Country

Social Services (Community Health) Spending

Instead of focusing on how to pay for healthcare – a perpetually-growing segment of our economy – we should re-direct our limited resources to impact basic social determinants of health, such as targeting education, housing, nutrition and poverty. Unlike healthcare, U.S. public spending on social services falls far below other developed nations. In 2009, the U.S. spent 9.1 percent of its GDP for aggregate social services versus the average of 15.8 percent spent by all 10 other wealthy countries.

Time to Move Upstream and 'Invest' in our Health - Aggregate Social Service Spending by Country

When combined, U.S. healthcare and social services spending ranks in the middle of the pack of peer countries, with a disproportionately higher amount spent on healthcare than on social services.

Time to Move Upstream and 'Invest' in our Health - Aggregate Health Care and Social Service Spending by Country

The U.S. is the only wealthy country where healthcare spending accounts for a greater share of GDP than social services spending – an “imbalance” our country has embraced. Over decades, we’ve allowed soaring healthcare costs to smother the necessary investments we must make to improve our community health. In other words, our country inefficiently relies on medical care and insurance to address problems that we fail to address upstream, at their source. An insightful reference on this subject comes from a book written by Elizabeth H. Bradley and Lauren A. Taylor – The American Health Care Paradox…Why Spending More is Getting Us Less.

What can we learn from this?

High healthcare spending in the U.S. has far-reaching economic consequences, such as wage stagnation, personal bankruptcy and budget deficits. Extensive evidence suggests that making the right investments in social well-being substantially improves population health outcomes downstream. For example, housing vouchers, home energy assistance and the availability of supermarkets in low-income areas are known to reduce obesity, diabetes and nutritional risk in children. In addition, availability of prenatal and infant nutritional assistance is associated with reduced infant mortality.

Realistically, the American culture has had little appetite for becoming more ‘socialized’ in tackling upstream problems, relying instead on the national ideology that spending more on healthcare will solve our health woes and improve health outcomes. But for meaningful change to occur, balancing healthcare with social determinant strategies must emerge both nationally and locally here in Iowa. The Iowa Healthiest State Initiative, a nonpartisan, nonprofit organization, is just one example of attempting to improve the physical, social and emotional well-being of our Iowa communities. This initiative is a good start, but other bold private and public initiatives need to be undertaken for real positive change to occur in healthcare outcomes.

Investing in our health upstream makes a great deal of sense. Spending for the ‘right’ community measures that impact health will provide better health outcomes for Iowa and our country. Such expenditures will take time to translate into positive health outcomes but we need to start investing now. The result may be cost-shifting from inefficient healthcare spending to re-allocating funds for social determinants that matter most, such as nutrition, adequate housing and education. By doing so, we will make our communities and state both healthier and more productive.

Controlling health costs and improving population health – we cannot have one without the other.

 

Giving to Others May Impact Your Health!

Posted on: 02.18.15 By: David P. Lind

Make A Difference in Your CommunityA blog I wrote last February, ‘100+ Men – A Creative Community Effort,’ discussed a Des Moines-based program, 100+ Men on a Mission, which was founded to help make charitable contributions to cash-starved community organizations. The sense of fulfillment for all who participate is quite profound.

A recently published study substantiates how donating to charity and helping others may actually improve the physical and emotional well-being of the giver. The Journal of Economic Psychology’s report also suggests that increases in charitable tax subsidies may actually spur the behavior of giving and ultimately improve one’s perceptions of his/her own health.

To embrace this concept of giving throughout the state, perhaps representatives from the Healthiest State Initiative and the Blue Zones Project might consider recruiting 100+ Men and 100+ Women to help develop opportunities for other Iowa communities. It’s certainly something to think about…

Imagine giving back to others and feeling good (and healthy!) about making a difference. This is a win-win proposition for all Iowans!

To learn more, please subscribe to this blog.

New Era in Iowa Healthcare (Needed)

Posted on: 05.15.13 By: David P. Lind

Value in Health Care DeliveryI’ve recently been visiting with healthcare providers around Iowa discussing how employers view health insurance and the value of healthcare delivered to their employees and family members. The discussion has been both open and honest. In fact, Iowa hospitals and physicians appear to be both interested and concerned with what they are learning.

My presentations evolve around four key observations that I have made over the past 29 years, both as a benefits consultant (my past life) and as a researcher. The intent of sharing these observations with the provider community is to convey the ‘pain points’ experienced by Iowa organizations regarding exorbitant health care costs and to begin a new dialogue of collaborating resources to find meaningful solutions in our health care world. After all, we are all in this mammoth problem together, right?

Here are my four observations:

  • Observation #1 – Health insurance premiums for Iowa employers have increased by 164 percent from 1999 to 2012. A great deal of uncertainty exists about the future of the health care ‘system.’

Year-after-year, employers continue to pay a handsome portion of the insurance premium. We know that take-home pay continues to erode for employees, as cost-sharing continues upward through increased payroll deductions and benefit plan alterations that include both higher deductibles and out-of-pocket maximums. This is clearly unsustainable for ALL of us. For communities to remain healthy and vibrant, employers must find solutions to this escalating problem.

  • Observation #2 – Iowa employers continue to embrace wellness initiatives, as they desire to have a healthier and more productive workforce.

Gradually we are morphing into a new social conscience of embracing healthier lifestyles – as more Iowa employers continue to assess and implement wellness efforts. We also have the Healthiest State Initiative and Blue Zones Projects™ in the news. The statewide Capital Crossroads Community Wellness Study reported that Iowa employers are open to partnering with community-wide wellness programs. For those employers currently without wellness programs in place, only three percent feel that wellness programs don’t work! This is encouraging.

  • Observation #3 – Lack of transparency in health care is a major concern and frustration to Iowa employers and their employees. Health insurance has become a major distraction to employers.

There is a growing belief that the ‘market’ approach does not work for ‘buyers’ of health care. In the next few years, will we see a gradual shift by employers to a more defined contribution approach by limiting financial support for employee premiums? Will value-based benefits begin to take hold that will nudge employees to use ‘higher value’ health providers and utilize approved medical procedures requiring less out-of-pocket exposure? Transparency of costs and outcomes are essential for the private market(s) to exist as health providers WILL definitely be held more accountable in the future.

  • Observation #4  – Health reform is viewed with great skepticism by Iowa employers.

The Accountable Care Act (ACA) will not solve the cost issue for employers and their employees. In fact, the ACA adds greater complexity in the insurance markets, forcing employers to search for opportunities that will relieve tensions and uncertainties. A ‘Provider Renaissance’ is sorely needed to deliver great value for the insurance premium being paid.

So what does all of this mean to the healthcare provider community?

Employers want to TRUST that hospitals and physicians will:

  1. UNDERSTAND the employer perspective, which is the need to be competitive by having a healthy workforce. Health providers must have the employers’ best interest in mind.
  2. CONSISTENTLY provide quality outcomes at reasonable costs – i.e. receive greater value for the dollar paid.
  3. COMMIT to do these critical things on an on-going basis – long term.

As mentioned in a prior blog, our fragmented delivery system is really not a “system,” but rather a concoction of multiple temporary or expedient remedies that attempt to solve our problems as we confront our health care needs. No one is at fault, yet we ALL are.

Now is the time for employers and the healthcare provider community to work together – starting with a meaningful and trusting dialogue that will result in concrete solutions.

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