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Rather Pay $2T per Year or $500B One-Time?

The answer to this question should be a no-brainer: Is it better to pay trillions of dollars annually in preventable chronic health costs, or to pay a cumulative $500-600 billion or so one-time to cover all  student college loan defaults or Great Recession mortgage losses ? Hmmm.  And what's the connection? We got the massive Dodd-Frank Reform in 2010 to prevent future financial catastrophes, and hopefully Great Recession 2.0--after 1.0 cost private lenders $535B, plus much collateral damage to families & the economy.  We then got  Obama-era regulations, subsequently reversed under Trump ,  to help prevent student loan defaults.  Now Biden has proposed eliminating all  public college/university, historically black college and undergraduate student debt .   This would make a big dent in about $585B in expected student loan defaults.  So where are the massive federal proposals to head off chronic diseases before they start?   With total US health spending at about $4T/year, that

Dueling Delusions in Health Advocacy: “Affordability” vs. “Personal Responsibility”

One side insists that we must have affordable health care for all.   The other side insists that individuals must take personal responsibility for their own health. For the “affordability” advocates, they mean that individuals should all be able to pay an affordable amount for health care--even if that requires government-funded free or highly subsidized health care for many, such as Medicaid & the Affordable Care Act. For the “personal responsibility” advocates,  they mean that many people choose to do unhealthy things, so they become unhealthy.  Why should “responsible” healthy people with healthy habits pay for the "irresponsible" ones?  In fact, doesn't free and subsidized health care encourage unhealthy behavior, since unhealthy people pay little for the consequences of their choices? What the affordability proponents don’t discuss, is whether the country can afford to pay for widespread free or highly subsidized health care--especially when 60% of adults hav

Is K-12 Education Patriotic Enough?

Questions have been raised about whether education in America is patriotic enough.  There are even proposals from the Oval Office to invest $5B in making US education more patriotic.  But what is "patriotic education" and how can we make K-12 ed more patriotic? These questions get very deep very fast.  If we want to educate people to become more pro-American, what is it that we want them to say is great about America?  And in cases where our country falls short of our ideals, how is our patriotism supposed to react to that?   Some people would say that it is unpatriotic to complain about America.  "Love it or leave it!"  Yet probably the most broadly revered part of the Bill of Rights, which in turn is probably the most revered part of our Constitution, is the 1st Amendment--guaranteeing freedom of speech and religion, the right "peaceably to assemble"... and the right to "petition the Government for a redress of grievances."  So if everything i

Medical Advice as Theater of the Absurd

By now, it should be clear that doctors' admonitions to lose weight and exercise more have little impact on our long-term, day-to-day behavior.  We all know this already from sad personal experience.  But we also know it from many studies, and from the multi-decade worsening in Americans' obesity and other chronic conditions.  The medical profession has been begging us for countless years to improve our health behavior--to almost no avail. Yet the fantastical headlines persist, even in publications like the Washington Post :  "Losing 13 percent of your weight could lead to big improvements in your health"    It is hard enough for adults to lose even 5 pounds and to keep it off--much less the 15-30+ pounds implied by "13%".  It is very rare to pull off sustained weight loss of this magnitude.   In fact, the only proven way currently to achieve this much permanent weight loss, on a whole-population scale, is the last resort, when all else has failed--bariatric

Our W.E. Op-ed with Heritage: A COVID-19 vaccine won't save us, but improving our health can

My op-ed with Lt. Gen. Tom Spoehr (Ret.) at The Heritage Foundation was just published! There is clear potential for nonpartisan approaches to child health & wellness. We can do a much better job of developing healthy habits K-12, so that Americans have a much greater chance of a healthy life!:   https://www.washingtonexaminer.com/opinion/a-covid-19-vaccine-wont-save-us-but-improving-our-health-can    

Covid Karma, Chronic Hope, K-12

 94% of US Covid-19 fatalities have been among Americans with chronic disease, according to recent CDC analysis.  Another way to look at this:  if we had pre-pandemic halved the current rate of 60% of Americans with 1 chronic condition and 40% with multiple conditions, we could have had roughly speaking less than 100,000 Covid-19 fatalities to-date.   Reducing chronic disease this much is not just hypothetical (though it is not easy either):  around ½ or more of chronic conditions are preventable.   The biggest catch?  They are only preventable at such a high rate, if we develop healthier habits in childhood.  If we enter adulthood with unhealthy habits, it is very difficult for people to change course.   Any strategy to dramatically improve overall health for most of the population rings hollow, if it does not start in childhood.   And any strategy to develop healthy habits in childhood rings hollow, if it is not centered in schools.  It is simply too expensive and logistically imprac

National insecurity: self-inflicted threats from our health (rant #2)

The national security threat of an unhealthy population extends far beyond difficulties in enlisting fit military personnel. The military budget makes up about 20% of the federal budget. In contrast, health costs are now almost 50% of federal spending, many times higher than in the past.  Continued increases in government spending on health care pose a growing threat to military budgets.   Military spending has been at roughly 3-4% of GDP for the last 30 years.  In contrast, total US health costs over that same period have increased from 12% to 18% of US GDP.   Employers have passed an increasing % of health costs on to employees, resulting in higher employee premiums & out-of-pocket spending.  Average health costs per person have almost doubled over the last 30+ years.  (Bad) health is absorbing a growing share of family spending, and reducing money available for anything else.  We are all paying for each others' health care, with the decreasing % of healthy individuals unsust

You thought 9/11 was bad? Pandemic threats to national security (rant #1)

We already knew that the chronic disease pandemic was creating a national security threat.  The military has stated for years that it is having trouble recruiting, since so many young people are obese & unfit to enlist .  Now we are realizing that our public health weaknesses have made us much more vulnerable to COVID-19...& to future infectious disease pandemics.  Not just our health, but our national security is at stake. Dr. Scott Gottlieb, until recently head of the FDA, just  warned that future pandemics could present an "asymmetric threat" to the USA (starting in video at 5:25).  Think how much damage less than two dozen Al Qaeda terrorists did--now think much bigger.   Nearly 3000 Americans died in the 9/11 attacks--compared to >200,000 now expected to have died from COVID-19 in the coming months. Americans' much higher chronic disease prevalence  magnifies this infectious disease risk.   Why wouldn't China, Russia, Iran or other hostile countries u

Will COVID-19 vaccines work for those with obesity?

The disturbing news linking chronic disease with much higher COVID-19 risks continues: any future  COVID-19 vaccine could be much less effective among the >107M Americans who are obese .  >40% of adult Americans are obese, including ~10% of teens & adults with severe obesity. We already know that people of color are at much higher risk of being infected, hospitalized & dying from the novel coronavirus.  Closely related to this, African-, Native-, & Latino-Americans are also much more likely to be obese & have other underlying chronic conditions.   Those hoping that vaccines could help reduce these disparities will be disappointed.  But we should have known better: for example, t he flu vaccine is much less effective among people with obesity. In addition, t hanks to past neglect & abuse of minority populations by those in power, non-whites are distrustful of government & less likely to take a COVID-19 vaccine, even if it is free .  The bottom line: many

Name Your Poison: Unhealthy Nutrition or COVID-19?

Compare the number of preventable deaths each year from chronic disease caused by unhealthy nutrition & inactivity to the fraction of that mortality from COVID-19.   One of the reasons we have invested so much attention & money on COVID-19, in contrast with the more perennially dangerous unhealthy nutrition & inactivity, is that everyone including those with power are at-risk of getting infected by the virus.   Since inactivity & unhealthy nutrition affect primarily non-white & lower-income folks with no power, they all get ignored.  As soon as COVID-19 vaccines hit, the powers-that-be will start trying to ignore disparities again--though hopefully the pandemic has at least raised consciousness enough to make that willful ignorance more fragile than in the past.

Re-born on the 4th of July

Each July 4 is an opportunity for Americans to remember their many blessings as a country, while also re-committing to improve what needs more work.   The racial justice protests this year are forcing us to confront racial disparities in many areas. Past racial injustice in society & the economy is reflected in major racial health inequities today.  K-12 schools’ focus has been aggressively narrowed in recent decades to achievement in reading, writing & math test scores.  To maximize school test prep time, the vast majority of schools, including Title 1 schools with their higher black & brown student populations, decimated physical & health & arts education & recess. We gained little in improved education attainment, but we did worsen health dramatically.   Now the pandemic has proven yet again, that we pay a very high price when we ignore our underlying health.  The main causes of chronic disease now--inactivity & unhealthy nutrition--can to a large

To Re-Open Or Not To Re-open Schools?--That is the Question!

My take so far on school reopenings based on very preliminary data:  - The countries with the best school reopening track records have typically had quite restricted formats such as very small, highly distanced class sizes  plus low country COVID-19 case levels per capita--many less infections per person than in the USA.  So we need to realize that we can't just copy what they did. - The biggest risk seems to be to teachers & staff.  Kids are less vulnerable & less infectious.  We need to consider all of them, and parents, too! - If we can flatten the state curve & have hospital capacity, it seems worth letting schools without local spikes reopen very carefully physically--including with recess!  - Then track closely & share immediately what is happening & learn from each other. - Let's get real:  Given the shortcomings of our hastily improvised hybrid teaching models, by this time next year, we could easily have lost on average 1/2 year or more

“The vulnerability of African-Americans to the coronavirus is a national emergency.” The Economist, May 30, 2020

The COVID-19 pandemic, aided and abetted by racial disparities from the 50+ year chronic disease epidemic, has harmed blacks much more than whites .  Who is really surprised, crocodile tears aside, that blacks are dying at much higher rates than whites from the virus?    As The Economist implies , African-American health has been worse than white health for centuries--but do whites really even care?  Major investments have been made in government programs, but the dismal outcomes remain.   When it comes to public health, it’s not about what you say you care about, or what you try to do--it’s about the results.  Exhibit A that it can be done: we reduced smoking by ⅔ in the course of more than five decades of hard policy and program work.  Smoking among black men declined even more than among white men--and by 2008 black teens smoked at half the rate of whites . What will we do about our inactivity & unhealthy nutrition epidemic--which is much bigger, costlier & dea

Chronic disease at core of Big Apple COVID-19 deaths

A recent summary of COVID-19-related deaths in New York City  confirms the much higher mortality risks among those with underlying health conditions.  Among the >80% of fatalities for which underlying condition status was known, only 0.8% of  those dying  had no chronic disease.  As we know from prior reports, obesity, diabetes, high blood pressure and heart disease are underlying conditions very frequently associated with novel coronavirus deaths. Furthermore, chronic diseases make up the vast majority of "underlying conditions" among those who die.  (See earlier blog post.)  This pandemic has been another wake-up call on the continued dangers of failing to prevent the widespread inactivity & unhealthy nutrition leading to epidemic chronic disease.  Will we start making a serious effort to develop healthy habits, particularly K-12?  Or will we continue to hit the snooze button as health worsens?

Not ready, not set, not go (Sweden rant #2)

We need to consider American core values and competences, before we can judge whether the USA should follow Sweden’s example.  We highly value human life.  We are very good at figuring out how to “manage” diseases on a large scale— given enough time (and at very high cost).  So we are trying desperately to postpone coronavirus spread until we can treat very high numbers of patients effectively.  “ Proning ” is one recent example, now remdesivir is another, of strategies that took us time to figure out, but which were worth waiting for.  And a recent study implies significant potential to re-purpose existing drugs and compounds quickly against COVID-19. Of course, the ultimate solution is a vaccine--and both Dr. Fauci & Bill Gates, who are normally quite cautious, have recently expressed optimism on rapid availability. Unfortunately, for decades we have grossly neglected to exercise our core competence in prevention, beyond tobacco.  We reduced US smoking by ⅔--but then d

Chronically Miscalculating with Pandemic Math: USA ≠ Sweden

There has been a lot of talk about using the “Swedish model” to more aggressively “re-open” the US economy.   We have to be realistic about what we can learn from a country as different as Sweden: it’s a bit like comparing a fast-food drive-thru to a smorgasbord.   For example, only about 20% of Americans are active in sports compared to about half of Swedes--this has a huge impact on underlying health, but unfortunately we are a long way from closing that gap. We have known for months--and was anyone really surprised?-- that underlying chronic disease appears to dramatically increase COVID-19 hospitalization & mortality.   Per OECD data, the USA has 2x worse diabetes prevalence than Sweden, and is 1.5x Sweden on overweight/obesity (undoubtedly even worse, when severity of obesity is considered).  In addition, Sweden has greater public trust in government & therefore more voluntary policy compliance.  Sweden has also had a 5x higher pandemic death rate than severa

Pandemic + Child Obesity = Even Worse News for Young Adults

Widespread child obesity, i.e., continual inactivity & unhealthy nutrition in childhood, turns out to be even more dangerous than previously thought--now that we are in the midst of the COVID-19 pandemic.   The New York Times recently described several studies showing the  high risks facing obese young adults   from coronavirus infection.   (This is in addition to the  shocking news last year from Johns Hopkins , that obesity will soon replace smoking as the biggest preventable cause of cancer!) Child health habits turn into lifelong destiny: the vast majority of children who are  obese, remain so as adults . And it gets worse: for about half of children who are obese,  child obesity turns into teen severe obesity . This dangerous trend continues later in life: by 2030,  almost 1/3 lower-income adults are expected , "with high predictive accuracy," to be severely obese ( >75 lbs. overweight). If there is any good news from the pandemic...perhaps it w

Fatal connections: COVID-19 mortality, chronic diseases, & unhealthy habits

The relationship between death risk from the novel coronavirus & chronic disease is becoming clear.  At first, age was mentioned as a key risk. But the real culprit for high COVID-19 hospitalization & mortality seems to be "underlying health conditions"--i.e., chronic diseases, which typically worsen health as people age.  The bottom line, even as we await more data in the coming months: a lot fewer people would be dying from COVID-19, if they had been more active, had healthier nutrition, not smoked, etc.--earlier in life. Governments have had a very mixed record in responding to the pandemic.  But they can prepare us better for the next time-- for future infectious and chronic diseases --by helping us develop healthier habits: "Among the 105 patients who had died in Italy as of March 4, two-thirds had three or more preexisting conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus. These chronic