So much of our health care dollars are spent wrestling with chronic diseases, particularly as the Baby Boom generation ages, and the plagues of heart disease, high blood pressure, diabetes, and stroke bloom and peak in an aging demographic.
Throw in dementia, Parkinson’s and Alzheimer’s diseases and we have a recipe to vacuum up most of our health care dollars now and for the foreseeable future.
It may seem like a perverse metaphor: Our aging family members, friends and colleagues are in long, long lines, awaiting their chance to be thrown off the cliff, and the clinical medic and pharmaceutical world are much like Holden Caulfield, catchers in a field of rye, trying to save them.
Do we practice triage [rationing] and attempt to save the ones closest to the edge who are responsible for driving the medical costs highest? Or, do we focus on prevention and interrupt the long lines approaching the cliff? Can we afford to do both?
Another stark way of looking at this precipice is that health care for diabetes and obesity and its complications threatens to be what will bankrupt us.
We are what we eat
There are other approaches, perhaps simpler, that can provide a more cost-effective approach: diet, exercise, activity, yoga, and connectedness to community.
Another part of the equation is to recognize that there may be other factors involved, which may force us to change the way we look at disease: more and more research has linked toxic contaminants in the food we eat and the water we drink to a predilection toward obesity and diabetes.
Recently, the American Academy of Pediatrics issued new guidelines for measures to lower children’s exposures to chemicals in food and food packaging that are tied to health problems such as obesity, metabolic changes, decreased birth weight, and endocrine disrupting effects, including reduced fertility.
The report, “Food Additives and Child Health,” found that exposures to these chemicals – added to food during processing or in food packaging – are disproportionately high among minority and low-income populations.
The chemicals found to be disrupting children’s health include:
- Bisphenols [BPAs], which are used in the lining of metal cans;
- Phthalates, used in adhesives and plasticizers;
- Perfluoroalkyl chemicals [PFCs], which are used in grease-proof paper and paperboard food packaging;
- Nitrates and nitrites; and
- Artificial food coloring.
Translated, we are what we eat, including all the toxic chemicals we ingest unknowingly, with long-term health implications. If the proclivity to obesity and diabetes begins with unwanted toxics in our food that disrupt our bodies, perhaps we need to rethink the way to look at and treat disease.
An approach, one being pursued by a coalition of nurses in Rhode Island, is to build a culture of health in a place-based approach to health care, putting the emphasis on neighborhood and community rather than being defined by the building where care is delivered.
Another approach may be more extensive access to yoga classes, which have been proven to reduce stress, high blood pressure, chronic pain and promote self-confidence. The biggest hurdle there is the willingness to create a way for yoga classes to be reimbursed through health insurance policies. The exercise of breathing in and breathing out is perhaps something our elected leaders should learn how to practice.
A third approach can be found in the work to develop health equity zones in Rhode Island, focused on developing solutions to health disparities by focusing on what the community wants and needs rather than what “providers” desire.
A fourth approach is neighborhood health stations, where health care becomes a one-stop shopping exercise. A new facility for a neighborhood health station in Central Falls will be completed in September, with the capability to provide primary and urgent care for more than two-thirds of the Central Falls residents.
Something deeper at work
Some problems cannot be solved by dispensing a pill or performing a surgery: the persistence of behavioral health and mental health problems in Rhode Island also require a different kind of changing the way we think about disease.
So much has been written about the opioid epidemic and the number of overdoses afflicting Rhode Island residents. One story line has not been part of the discussion: the impact of what researchers call the diseases of despair – the fact that the leading cause of death in Rhode Island for many young adults ages 25-34 is from alcohol, suicide and drugs.
Once again, it requires us to have a different kind of conversation about what we mean by disease and what we mean by health.