Healthy Future US Blog

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 reduce...

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...

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 goo...

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...

The recent health news double-feature was really scary: 1.  40% of Adults Obese 2.  1 in 5 Adolescents with Prediabetes Then came the even-more-shocking news on the “sequels”: For adults: “ Severe obesity  is likely to become the most common BMI category among...low-income adults”--  close to 1 in 3 >75-100 pounds overweight by 2030 --when about 50% of adults will be obese nationwide . For teens with prediabetes:  “However, compared with adults, decline in β-cell function seems to occur at an accelerated rate resulting in relative insulin deficiency and progression to overt type 2 diabetes  with insulin treatment needed to control hyperglycemia within a few years after diagnosis .” Let us be clear what this means: High child obesity (~20% nationally now) is leading to very high adult obesity (40% now, going to 50%+) and  severe obesity (1 in 12 adults now, going to 1 in 4 in 2030 ). Un...

Just submitted the following letter to the editor to The Atlantic, in response to     https://www.theatlantic.com/video/index/598297/physical-education/ : Making grants without requiring high-quality evidence-based strategies, as Texas Fitness Now did, often does not end well--especially when combined with “bad PE” at a number of schools.  But contradicting the stereotypes,  Desy, Peterson & Brockman showed  that “gym” is actually the favorite subject of many middle-schoolers.  So beware the unintended collateral damage:  continuing to slash PE (& recess) risks further  demotivating large numbers of students , many of whom are already at-risk.  “No PE” may be even more of a threat to student engagement & success than “bad PE.”  And we should not look at this issue in isolation.  How can we keep cutting physical education, as we enter our 5 th  decade of a deadly serious  chronic disease epidemi...

There were a number of good insights and promising strategies described in the Healthy Eating, Active Living special supplement of SSIR Summer 2019.    Yet the authors also admitted that child obesity and adult chronic diseases continue to grow. One key weakness of the social determinants of health (SDOH) framework is that there are so many challenging “determinants,” that scarce resources for change can get spread and diluted.   So we end up with good SDOH change anecdotes—while actual state & national health statistics worsen. To maximize impact, especially to reach the tipping point of actually reversing 40+ years of worsening health habits, we need to prioritize.   One highly promising “80/20” (and, yes, SDOH) strategy is through K-12 schools—literally with 20% of the US population, for 13 years, at just the right developmental stage to learn and change.   There are scalable, low cost, school-based strategies that dramatically increase fitne...