Prevention and Wellness – we are train wrecks waiting to happen

As a retired benefits professional, both as a consultant and manager of an employer benefits program, I have been involved with numerous healthcare prevention and wellness efforts. I have worked with wonderful colleagues who put in motion terrific ideas and measured their success. And, if not working well, they tweaked or scrapped them, as the key is to prevent illness and injury. The reason – we are train wrecks waiting to happen. If we don’t take care of ourselves now, issues will manifest themselves later.

March is national Colorectal Cancer Awareness month, so you may have seen more commercials on getting a colonoscopy. There is no better preventive exercise than getting a colonoscopy whether you are male or female. At the age of 55, I have had the “pleasure” twice and each time they have found pre-cancerous polyps, which they can and did remove during the procedure. If you are over the age of 50 and have not had one, please see your doctor. The worst thing is the cleansing liquid that you need to drink the afternoon and evening before. The procedure itself is twenty minutes in length.

Each October, we celebrate Breast Cancer Awareness month. Unlike colonoscopies, mammograms should start at an earlier age, especially if you have a family history. And, unlike colonoscopies, reading a mammogram is science and art. It takes a trained eye to read them and there are some false readings. I have two suggestions. First, start early with self-examination. If you don’t know how, ask someone who does. You know your body better than anyone, so you may sense something is amiss.

Second, if you do get a mammogram and get a positive result, don’t panic and do the follow-up with an oncologist.  Even if the oncologist says everything is OK, it is worth the trouble and expense. If you get a negative (or there may or may not be an issue) mammogram and feel it is not correct, get another one. In the mid-1990s, we ran a mobile mammogram (thanks Mary!), which conducted 11,000 screenings for our employees, irrespective of whether they signed up for the employer healthcare plan. We detected 9 cancers. That is nine lives who may have been saved, which makes the cost savings to the employees and employers meaningless when compared to a life saved.

While these are of critical importance, most people die from heart disease, including and especially women. So, every month should be heart disease awareness month. One of my old Global Health and Wellness colleagues said one of America’s greatest exports is obesity. We have shared with the world our affinity for fast food and each nation has made it their own adding other unhealthy items to the menu. In Mexico, you can get a burrito with your Big Mac at Mickey D’s. I should add the US is the most obese country in the world according to the World Health Organization with over a third of Americans with a BMI greater than 30, although Mexico is giving us a run for our money.

There are a number of programs and diets that attack people, especially women, from TV and magazines. Dr. Oz is great, but he has a new idea on every day, so you are blitzed by information and are hamstrung on what to do. You cannot do everything Dr. Oz suggests. So, here are a couple of simple ideas that we each can do (please do more if you are and can), that will help you with your heart health.

Walk to better health. That’s it. Walk after dinner or to run errands. Walk the dog or with a friend. Even if for only five minutes, just walk and you will see a difference.

See a doctor for a preventive or wellness check-up.This will be one of biggest benefits of Obamacare. People will now go to the doctor for preventive visits. High blood pressure and high cholesterol can be managed, but you have to know.

– Eat smaller portions. This is the most sustainable diet you can do. Start by leaving “bites for the cook” when you eat. Just don’t overload your plate or when you eat a snack, put the product in a small bowl and don’t eat from the bag or container. We keep lightly salted mixed nuts and small fruits (blueberries, grapes, e.g.) around and use them as snacks rather than chips.

There are many more ideas I could throw out, but let’s stick with those three. Since I retired, I graze during the day eating five or six small meals – the three main meals and usually two or three snacks. I try not to overeat at any of them. I would encourage you also to eat more calories earlier in the day and try not to eat too late, so your body can burn the calories.

I would ask my readers to share their ideas as well, but my main purpose is to suggest small steps that you can do and sustain. Diets will eventually fail unless you make changes that you can live with each day. Walking is easier to start and continue and, if you miss a few days, you can easily pick it up again. Best wishes on keeping your train on the track and avoiding the train wreck later in life.

 

 

With Obamacare showing more success, let’s expand Medicaid in the remaining states

Now that the current phase of the Affordable Care Act (ACA) is showing success it is time for the states who did not do their part to seriously consider expanding Medicaid, maybe taking a cue from a successful, bi-partisan variation in Arkansas. As of March 27, over 6 million Americans have signed up for the exchanges under the ACA, with another over 6 million benefitting from the expansion of Medicaid in the states that did so. Further, you cannot be excluded from coverage due to pre-existing condition nor can your be kicked out once you become ill or disabled, which is a huge plus.

This success is on top of what had happened in earlier phases of the ACA. Over 3 million adult children under the age of 26 have been able to remain on a parent’s plan, which is in addition to the above. Among other early adopted features prior to 2014, the ACA eliminated the lifetime benefit limits, eliminated the preexisting condition for children, required some additional health prevention benefits and limited profit margins on policies for insurance companies which resulted in some premium refunds the past two summers.

The ACA is here to stay, but could stand some additional improvements. While complex, it has moved the ball forward in a major way and will continue to do so. Yet, part of the ACA has been hamstrung by various states that chose not to expand Medicaid for those beneath the poverty level, including the two Carolinas. For example, like other states who failed to do this, the two Carolinas rank low on overall healthcare and child poverty, per the United Health Care Foundation and Center on Budget and Policy. NC ranks 33rd in healthcare and 39th in child poverty. SC is worse off ranking 46th in healthcare and 48th in child poverty. More on this can be found on the following post.

https://musingsofanoldfart.wordpress.com/2013/06/18/why-are-the-states-with-the-worst-healthcare-not-expanding-medicaid/

According to the RAND Corporation, The Commonwealth Fund and Economic Policy Institute expanding Medicaid would not only be good for those in need, it will help the economies in those states. In my home state of North Carolina, for example, the reason stated for not expanding Medicaid is the administration problems it already has. That is true as the current leadership is not steering the ship very well. An unstated reason for these states is political as the leadership are not advocates for Obamacare. Yet, other Republican states have embarked down this path.

But there is another option for Medicaid expansion, which has been successfully rolled out in Arkansas with 83,000 enrollees so far. This bi-partisan alternative uses the federal support for Medicaid expansion covering the enrollees in the exchanges. This transfers the state’s administrative burden to the insurance companies. In North Carolina and other states with Medicaid administration issues, the Arkansas model would be worth consideration.

As a retired benefits professional, covering more people will benefit not only those in or near poverty, but hospitals who are struggling and our economies. People with coverage will seek treatment before troubles get worse, seek treatment from the more appropriate source and have dollars to spend on other basic needs. Since the absence of good healthcare coverage is the number one reason for personal bankruptcy per The American Journal of Medicine, having coverage can help people weather the storms in their paycheck to paycheck living.

So, it is time for these states to make a move. Under either Medicaid expansion model, people in need would benefit. So, would their state economies and hospitals, especially in rural areas where poverty is so prevalent.

 

 

Miami 2017 – Billy Joel may need to change the ending with the encroaching seas

In one of Billy Joel’s more memorable songs written in the 1970s, “Miami 2017” sometimes referred to as “The Night the lights went out on Broadway,” he sings of how everyone moved away from New York to Miami when it got so bad there. Here are the concluding lyrics: You know those lights were bright on Broadway. But that was so many years ago… Before we all lived here in Florida. Before the mafia took over Mexico. There are not many who remember. They say a handful still survive… To tell the world about… The way the lights went out. And keep the memory alive…

However, Joel may need to change the song ending as Miami is being encroached upon by the sea and it is not anticipated to let up. Per a PBS Newshour news article led by Kwame Holman, sea water is now coming up through the sewage system into the streets, the only place the water can escape. And, unlike Hurricane Sandy that leveraged off the rising seas to wreak havoc, this is happening without a hurricane, which makes it even more scary. Here is a link to the article:

http://www.pbs.org/newshour/bb/south-florida-rising-sea-levels/

I am not implying Miami will be under water by 2017, but I am saying that the predictions of a meter rise in the seas (between 39 and 40 inches) by the end of the century, may be too optimistic. Miami’s Dade County has been joined by three other adjacent counties to plan for the rising sea. Per the article, Eric Carpenter of Miami Beach Public Works Department said, “We have done our storm water management master plan that was adopted in 2012, and that had identified approximately $200 million worth of improvements that we needed to do over the next 20 years in order to keep pace with sea level rise and addressing flooding concerns within the city of Miami Beach.”

Per Holman, “Miami Beach is not alone in addressing sea level rise. South Florida has become a model for regional cooperation on this issue. Projections by a four-county climate change compact were turned into an action plan with more than 100 recommendations. Those now are being reviewed. Some have been adopted by county governments. Broward County Mayor Kristin Jacobs has been at the forefront of South Florida climate change discussions and has earned national recognition for her work.”

The dilemma is the $200 million estimated fix will likely not be near enough, some thinking it may need to be doubled. Miami is right at sea level, so any rise of significance will be problematic. Yet, the fact four counties have joined together to discuss the problem and identify action steps is encouraging. The logical concern is how to pay for what needs to be done. So, mapping that funding strategy must be a key part of the equation.

Several states have accepted reports of the 39 inch plus sea level rise – Virginia, Louisiana are two that come to mind. Unfortunately, I sit in a state that refused to accept such a report and would only accept one that projected forward off the previous 100 years’ results. So, North Carolina is hoping the seas only rise by 8 inches by the end of the century. North Carolina is literally holding back the sea with legal briefs. I applaud South Florida for doing what we are not in NC. Climate change is real, we are seeing it already and we need to do something about it. I hope that other communities share Miami’s concern and plan accordingly.

Boys with Toys – when factions fight, no one wins

Maybe our world is more connected with social media, so I may simply be more aware of various factions fighting for turfs around the world. But, it seems like we are having more useless fighting than ever before. Part of the reason may be the fall of various iron fisted regimes such as in Iraq or with the dissolution of the Soviet Union, although Vladimir Putin wants to put all the stuff back in place under his iron fist.

As I review this constant state of fighting, two major conclusions can be gleaned. First, you do not see women leaders fighting over turf like men do, so it is grown up “boys with toys” doing all of the harm. Unfortunately, the women citizens are the ones who pay the dearest price as they are raped, pillaged, stolen, mistreated, or given lower status. Second, when a region has fighting like this, it will not flourish economically. No one in their right mind would want to enter a country to do business as the risks are too great. And, the men and boys who should be working their livelihoods are too busy finger-pointing and saying that group is responsible for why I am poor.

On the business front, now that Russia is more entwined with other economies, they will suffer from the sanctions, but more importantly from less commerce, as no one will trust Putin to do business with them again. He was already corrupt before, but now you would need a serious return on investment to risk doing business with Russia. Either that, or you are obligated to do business with them as there is no other market. There is no better example than to look at the two Koreas. You have South Korea who is flourishing with open markets and vibrant cities. Then, you have North Korea which is a totalitarian disaster where people have few rights and have to acquiesce to the Boy Emperor or get executed or sent to a labor camp. It is not a surprise more North Koreans go hungry than their southern neighbors.

But, back to the violence of certain areas. It is one thing to be under an iron fist with few rights. At least you know what you are dealing with and people can make do. It may not be a great life (or even a very good one), but it can be safe if you keep your nose clean and don’t make waves. Yet, the areas where extreme groups are fighting each other and blaming other groups or groups they support for their woes, there is little hope for stability. To get there, the violence has to stop or be managed to a minimum. Until the violence is stopped, people will live in fear and poverty. Until the violence is stopped, women will be maltreated as they are easier prey and considered such in the minds of brainwashed boys with toys.

The word “brainwashed” is appropriate as the boys (and some girls) are carefully taught by extreme leaders to hate others. Remember the line from a song in Oscar Hammerstein’s South Pacific, “You have to be carefully taught to hate from an early age.” It is their fault, not yours or mine. To convince a young person to strap on a bomb and self detonate is an act of cowardice on the leader’s part. He has “wound up” a boy with a toy that will kill people as well as the young person. Until leaders within these groups or related groups stand up to these cowards and say this is not right, until the women stand up and say this must stop, and until the young people realize that they should not listen to this propaganda, the violence will continue.

My friend George Dowdell wrote a post recently about the contributing factor violence plays in poverty. He eloquently defines it as the lack of justice. Here is a link:

http://georgedowdell.org/2014/03/18/broken-justice-systems-the-legacy-of-colonies/.

Until the violence ends, poverty will not end. And, for those in the US reading this, we have communities in America where poverty persists because of the violence. Poverty exists because the opportunities are too few, where boys are drafted early to be part of extreme groups. Until we stop this everywhere, poverty will continue to exist and no one will win, including the boys with toys.

 

 

Countdown – Too many people to sustain long term

I watched a fascinating interview with Alan Weisman, the author of the book “Countdown: Our Last Best Hope for a Future on Earth” the other day in which he said environmentalists are failing to talk about the major problem we face as a planet which is having too many people to sustain life. I have written before about how many people our earth could sustain and the answer varies based on how much we consume – if we consume like the average Rwandan we could support over 15 billion; however, if we consume like the average North American it is under 3 billion. With our current population of 7 billion, Weisman believes we need to plan our way down toward the smaller number. The following is a link to a Los Angeles Time article on the book.

http://articles.latimes.com/2013/sep/20/entertainment/la-ca-jc-alan-weisman-countdown-20130922

He noted the big reason we have so many people is we have created chemically leveraged ways of growing more food. Yet, even with that people are starving. Further, the chemicals are now being seen as harmful to the environment and our resources. But, it is not just the food – it is the water which is the “new oil” per Steven Solomon’s book called “Water: The Epic Struggle for Wealth, Power, and Civilization” as well as our other limited resources. So, in his mind, we have to manage the decline of our population to survive.

He cites a good example in his book where Iran used extremely reasonable means to curb their population growth and did so in a non-coercive manner. The Iranian approach was even more effective than China’s one child per family mandate. After the revolution in 1979, Iran was soon invaded by Iraq. To stave off the Iraqis, more children were needed, so families were encouraged to have more. Once the Iraqis were pushed back, the leaders saw they had far too many people and that would cause unrest. So, the leaders convinced the Ayatollah of the problem so he issued a four-part edict that made much sense and has been successful:

1) Beyond a replacement number of offspring for the family, it is more than OK to use contraception.

2) Contraception was made readily available to Iranian citizens.

3) Pre-marital counseling on the cost of raising children was made mandatory.

4) Girls were encouraged to stay in school and get an education.

This last point is vital as data indicates the better educated the family, the fewer children they tend to have. He also noted in the area around the Vatican resides some of the more educated females per capita and they have a very low birth rate.

I have not read Weisman’s book yet, but look forward to doing so. But, I think his message speaks loudly to all of us. If we are going to sustain ourselves on this planet of ours, we need to factor in population planning along with our environmental planning. We need to have a more manageable and sustainable population.

Reflections on the week it was – intimidation and bigotry abound

Looking back at a few occurrences over the course of the week, I observed Vladimir Putin is quite good at influencing outcomes and bad behaviors. Even ministers are not immune from his lessons of bigotry. This is a key reason he is unlike other Soviet leaders (word intentionally used) as he is a very skilled, scary and corrupt politician.

Crimea election shows 96% plus favor joining Russia

History has shown when you intimidate voters, the election results will favor your cause. A few weeks before, North Korea voted to continue with Kim Jong Un with 100% of the vote. Something about killing your own Uncle for not bowing low enough or clapping hard enough has a tendency to sway voters. Saddam Hussein used to win elections with 98% of the votes as well. Hussein was not too tolerant of dissent, but was smart enough to allow 2% vote against him to show the world he is fair. I would not want to be in the 2% in Iraq back then or 4% in Crimea this week, as you might not be around much longer..

In Crimea, the native Tartars and pro-Ukrainian voters decided to stay home, since there was evidence of dissenters disappearing and having big “X’s” marked on your door can make you feel unwelcome. Yet, I found an interesting statistic. One district had 124% turnout. That is a turnout any Tammany Hall politician would love. It appears, if you had a Russian passport, you could vote. So, people who are not even citizens of Crimea voted to join Russia. You could have sensed something was amiss when reporters were having their cameras thrown to the ground and independent election officials were not allowed in to verify results.

Two final comments. First, if Crimeans want to join Russia, I understand that, but at least have a fair, democratic, and constitutionally (Ukraine’s not Russia’s) supported vote and not one that looks and smells like it was rigged as this one was. Second, as I said in an earlier post, I would not put it past Putin to send in his own thugs to stir up trouble in a community and then send in troops to provide security. This is an old school strong-arm tactic and I believe it was used in Crimea and is being used in other parts of Ukraine. PBS Newshour corroborated this with their belief last night when they spoke of a seemingly orchestrated set of eleven demonstrations in an Eastern Ukrainian city at the same time. It is too much a part of Putin’s nature to believe he did not puppeteer this outcome in the manner I described.

Franklin Graham applauds Putin for denigrating the LGBT community 

Reverend Graham published an article that said he admired Putin’s stripping away the rights of the LGBT community in Russia. He did not support other things Putin has done, but he took a shot at our President and Attorney General for supporting non-discrimination of gays and lesbians and heralded Putin for discrimination. From the bible I was taught, Jesus was inclusive. In fact we used to sing a bible song, “Red and yellow, black and white, Jesus thinks we are out of sight. Jesus loves the little children of the world.” I have searched my memory banks, but cannot recall an exception on whether they were gays or lesbians in the song or in Jesus’ Golden Rule.

I have a very low tolerance for bigotry from the pulpit and have written several posts about my distaste for when ministers misuse the faith the congregation has placed upon them. Per the song from the movie “South Pacific,” you have to very carefully taught to be a bigot. My mantra has been when religion is inclusive it is at its best and when it is exclusive it is at its worst. Let me go one step further. When religion is bigoted, it is wielded as a weapon to divide. I have known many ministers in my day and they are by and large the most wonderful people and give much of themselves. But, just because someone is a minister does not mean they are immune to biases and mistakes. They are imperfect just like everyone else.

What disappoints me about the younger Graham is his father was so admirable in cutting a path of inclusion for all. Using an old phrase, he was a “Big Tent” preacher who wanted everyone to come and hear the word of God. That is the way it should be. Franklin would ask you to complete a survey and if you checked the wrong boxes, you would not  be allowed to enter the tent. He needs to spend some more time with his father and ask for guidance on how to be inclusive.

I will reiterate what I said before. Vladimir Putin is a thug, but a skilled one who uses people’s biases to divide and achieve his purpose. Franklin Graham took the bait and tried to appeal to a base of bigotry that is being cultivated in our country. I am hopeful many will see Putin’s true colors through this process and will not tolerate bigotry from anyone, but especially a religious leader.

The Anti-Charity Charity

In his book “Toxic Charity,” Bob Lupton writes from experience that charity should be reserved for true emergencies*.  When a person loses his home (or is about to) due to sudden natural or economic causes, then people stepping in to help is definitely in order. Yet, after the emergency subsides, the more efficacious way to help people should change. We definitely should help people, but do our best not to do for them what they can do themselves.

I am involved as a volunteer with an agency that helps homeless families. We believe in empowering our homeless families—working in partnership with them to secure safe and stable housing and to create lasting change. These are things we know are necessary to break the cycle of generational poverty and become self-sufficient. When families have permanent housing, strong personal relationships and motivation to change, families will have the best chance to move out of a life of poverty and into a life of self-sufficiency.

Our families are working families—people you meet when you go to your doctor’s office or your child’s school, etc. Many have lost their homes due to a reduction in work hours, a medical crisis, domestic violence or some other financial or social setback. Our families were living paycheck to paycheck and with one small change, their world was turned upside down.

To access the full support of our agency, our families have to do their part. Families attend classes to learn better budgeting and financial skills, and they meet weekly with a social worker who challenges and encourages them to make better decisions. Also, after saving for a down payment, they work with a housing specialist to obtain affordable permanent housing. Families also receive supportive services from volunteer mentoring teams, which we call “Hope Teams.” Our model is simple—to help homeless families help themselves.

To be the best stewards of our families, funders and volunteers, we constantly evaluate our model to ensure that we are creating lasting and permanent change in the lives of the families we serve. In our last fiscal year, 91% of our families were self-sufficient after completing the housing part of our program. And, we just completed an exhaustive measurement exercise to learn that 88% of the families that exited our program into housing have sustained their housing on their own after three, six, twelve and twenty-four months milestones.

Our staff and Board of Directors know this model serves our clients in a respectful and effective manner—and we have the outcomes to prove it. The key takeaways are to help people climb the ladder, but not climb it for them. And, entrust the people closest to the client figure out the how to tweak or improve the model. Finally, measure outcomes. It is important to use your funders’ dollars judiciously and your volunteers’ time and efforts wisely. This stewardship is essential to success for our families.