Matt Masiello, M.D., MPH

Category: Health Policy

  • Health is Everywhere

    BY MATT MASIELLO, MD, MPH
    Often times the feeling is the opposite; it is illness that is everywhere, not health. With the U.S. population experiencing a continuing surge of chronic illness, costing this country, we Americans, 80% of the money we spend on health, why should we think that illness is not here to stay. Sadly, the U.S. is not leading the international charge in maintaining and sustaining maximum health for all citizens. The present generation of U.S. children could be the first to have a lower life expectancy than their parents’. Forty-six-plus million individuals in this country live without health insurance and that number will only grow as the economy suffers.

    “Sick Around the World,” a Public Broadcasting Station (PBS) documentary, reviewed the stark comparisons between the health care systems of several countries to that of the U.S. The one interesting question asked of the health care leaders of the five countries was: “Would a citizen of your country ever go bankrupt over a hospital bill?” The response was “not possible” or “never,” along with a facial expression of surprise and wonder that the question was even asked. When the small country of Taiwan had the opportunity to re-invent their health care system in the 80s they identified the advice of those countries considered to have the best health systems. When asked, and again with a polite pause in the conversation, the Taiwan spokesperson responded that the U.S. was not one of those countries.

    These countries certainly have issues and obstacles in providing the very best health care. However, “health” is considered a human right and thus they are committed, through political will and leadership, in making it work.
    Ilona Kickbusch, a well-known health care author and academician, who has worked and lectured on both sides of the Atlantic, speaks of the roles of hospitals in the “health society of the 21st century.” At the 2007 World Health Organization-Health Promoting Hospital Network (WHO-HPH) meeting in Vienna, Austria, she eloquently and simply stated that “health is everywhere.” And in that environment she describes the important role of hospitals in identifying and utilizing “health.” Health care professionals from around the world gathered at the annual event to discuss how hospitals can identify themselves as public health advocates for their patients, hospital staff, community and environment. David Ollier of Hospitals and Health Networks wrote of the minimal participation by the U.S. in the international organization in his 2007 article, entitled “American Exceptionalism,” where he comments on “where one is a lonely number.” Nicely, so that “one” (hospital) is in Pennsylvania.
    The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” In the U.S. we do a good job in curing diseases and treat illnesses for some, not all. We are less proficient in the area of hospital based disease prevention, health promotion or public health or public health advocacy.

    So, what can U.S. hospitals and health care systems do to realize and benefit from the fact that health care can also be everywhere? First, there is the issue of leadership. We need a different type of health care leader. Hospital CEO’s, Presidents, Trustees should have training, experience, background and appreciation of the broad social and health issues of our day, as well as manage the day to day operations of the health care system. These new health care leaders must find that common ground of how hospitals can obtain the optimal profit margin as well as strategically serve as public health advocates for the communities they serve. Second, the international arena is the “health” classroom where we can learn. If we have the desire, fortitude and leadership to redesign our U.S. health care system our hospitals, managed care organizations and political leaders must make the effort to identify this new health care leadership as well as reach out internationally for this level of expertise. The WHO-HPH network would serve as a viable resource.

    According to Ilona Kickbush, hospitals must begin to live in the four domains of health – medical health, personal health, public health and the health market. In the health market alone, she describes 18 categories of potential activity. To participate and excel in these activities a new kind of political and health leadership must rise up and be able to speak beyond the important but limited topics of “access to care”, “health insurance for all”, or “reimbursement for clinical services.” For the U.S., we need to strategically create the balance between the attention and funding we provide for treatment of chronic illness and technology and the more encompassing “health society” of health promotion, wellness and disease prevention. As steam was an economic driver in the 1800s, steel in the 1850s, electricity in the early 1900s, the automobile in the 30s and information technology in 2000, health must become the driver in the decades to come. Kickbush and others have commented on these comparisons, with wellness, health promotion and medical technology as being the economic driver for 2050.

    And lastly, we must also be willing to retrain our health care professionals. Though we may need more nurses at the bedside of our hospitalized citizens we also need nurses, as well as physicians, who are trained to “clinically” promote the health of the patient beyond that of the hospital bed and back to their homes and work places. Europe, Asia and many other countries are forging ahead on these health care practices. We must work to change how we do health in America.
    It is time we counter the impression and opinions of others by reflecting upon a quote from Winston Churchill: “Americans are a wonderful people in that they always find the right answer…after they have tried every wrong answer first.” We can do better, we must do better, and we must find the right answer to better health.

    Dr. Matt Masiello, Director, The Center for Health Promotion and Disease Prevention, Windber Research Institute & Windber Medical Center, and Project Coordinator (U.S.-based), International HPH Network, World Health Organization-Collaborative Center (WHO-CC), Copenhagen Denmark, can be reached at m.masiello@wriwindber.org or (814) 619-6168

    4 December 2008 http://www.wpahospitalnews.com HospitalNews

  • Preventing Bullying Through Science, Policy, and Practice

    Publication

    Released: May 10, 2016

    Bullying has long been tolerated as a rite of passage among children and adolescents. There is an implication that individuals who are bullied must have “asked for” this type of treatment, or deserved it. Sometimes, even the child who is bullied begins to internalize this idea. For many years, there has been a general acceptance and collective shrug when it comes to a child or adolescent with greater social capital or power pushing around a child perceived as subordinate. But bullying is not developmentally appropriate; it should not be considered a normal part of the typical social grouping that occurs throughout a child’s life.

    Although bullying behavior endures through generations, the milieu is changing. Historically, bullying has occurred at school, the physical setting in which most of childhood is centered and the primary source for peer group formation. In recent years, however, the physical setting is not the only place bullying is occurring. Technology allows for an entirely new type of digital electronic aggression, cyberbullying, which takes place through chat rooms, instant messaging, social media, and other forms of digital electronic communication.

    Composition of peer groups, shifting demographics, changing societal norms, and modern technology are contextual factors that must be considered to understand and effectively react to bullying in the United States. Youth are embedded in multiple contexts and each of these contexts interacts with individual characteristics of youth in ways that either exacerbate or attenuate the association between these individual characteristics and bullying perpetration or victimization. Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, this report evaluates the state of the science on biological and psychosocial consequences of peer victimization and the risk and protective factors that either increase or decrease peer victimization behavior and consequences.
    Learn more about the report: nas.edu/ScienceOnBullying

    For more information, or to purchase this ebook: http://www.nationalacademies.org/hmd/Reports/2016/Preventing-Bullying-Through-Science-Policy-and-Practice.aspx

    #MattMasielloMD

  • Welcome pediatric colleagues

    Today, pediatricians, must step up to be politically and socially more active in addressing gun violence in America. The AAP and we, as individual pediatricians obligated to keep our children safe and healthy, have been failing; worse, we have been silent.

    Today, I am on the search for at least one pediatrician from each state. I will not move forward until we have identified that first 50. I ask that for this first cadre of pediatric activists you  have a degree in public health and at least five years of developing community based initiatives.

    I  ask that you be willing to collaborate and sacrifice.

    I ask that you send me that one significant paragragh about yourself and another on how this first group of healthcare activists will move deliberately and decisively to stop the carnage of our children, teens and young adults as well as the  inaction by our politicians and leaders of our  professional health organizations.

    I will be back to you in a week.

     

     

  • Public health gets least money, but does most

    WASHINGTON — Just three cents of each U.S. health care dollar goes to public health even though it plays a far bigger role in keeping Americans well than medical care, a top federal official said at a forum presented by USA TODAY and insurer Cigna.

    READ MORE…

     

  • Why we dislike politicians and the media

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    Today, on CNN, Candy Crowley had Rep. John Fleming (R-LA) and Dr. Ezekiel Emanuel on to talk about the effects of Obamacare; both are physicians. However, it was soon obvious that the two were not to agree on anything. But, what made their conversation regress to the malodor of current day politics was that Fleming, who may have felt he was loosing the argument, began attacking Emanuel’s profession, his character and role in life.

    To Emanuel’s credit he did not go down this path. Rather, Fleming was the bully. In addition, Fleming sounded like a bully who could not defend his position with data, logic and common sense. In the eyes of many Americans, the media is right behind the politicians as we are so disappointed and frustrated with this profession as well.

    With a keen awareness of what was happening, the meanness of partisanship, Ms. Crowley could have interjected a comment or asked why Fleming was attacking Emanuel as a person and not just his ideas or opinion. Nonetheless, she did not. Instead, she asked scripted questions, but not the questions of frustrated Americans.
    Our politicians continue to be disappointing with the media right there with them. They want their moment of rightness regardless of the consequences .

    This all points to the need that it is the home, community and state where we need to make it happen. Keep politics local and let’s disregard the behavior of our national leaders and the media as they continue to demonstrate their bad behavior. Hopefully, we will have the opportunity to clean the slate of all present national leaders in the upcoming months.

  • U.S. Health Care (Obamacare) – “Correct and Enhance” , A Subject Not For Our Politicians to Deal

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    Ted Cruz is not the only guilty party. The likes of Ron Paul and Cruz are misrepresenting labor union leaders and declaring Obamacare a plot similar to Nazism. Though the democrats have some proof of early success regarding the latest reports on patient access and a leveling off of health care costs, they are as unethical and misleading as their republican colleagues whom they compare to bomb-strapped terrorists.

    It appears that our politicians are not only making it more difficult to understand the need for broader and deeper health care coverage and a path to a healthier society, they now appear to be in a position to close down the government. Once again, the lives of thousands of Americans will be negatively affected. Closing the government will affect Wall Street, thus our pensions. Once again, their actions make us look weak, mean-spirited and indecisive to the rest of the world. And, in the rest of the world, especially in the more advanced industrialized countries, people are mostly happy with their health care systems. Or, at the very least, they are paying less with better results. For many countries, healthcare is a right, not an entitlement. Keep in mind, however, that it took generations; decades, to evolve and improve these international health care systems.

    Therefore, to start this conversation, let us start with the comment by Senator Ted Cruz. He offered, in his 21-hour marathon monologue, the question of why should, we, Americans be in a position to lose our physicians. He is assuming that we now have control over what physician we can choose and maintain; the furthest thing from the truth. We do not have such control now, nor will we in the foreseeable future. For the vast majority of physicians, they, themselves, are controlled by the very expensive managed-care or health care systems that provide them a pay check every two weeks. And, for a growing number of physicians, their salary is ultimately adjusted no longer by being good and ethical and showing up for work every day, but by how many patients they see in a day, or how many tests they order or not order. Senator Cruz’s assumption is that said physicians will magically be available to us for decades. The system is the deciding factor, not the patient nor the physician. Thus, he is wrong. Senator Cruz is also assuming that a U.S. physician is maximally trained and in a position to assist us along the path to better health. By better health I do not mean what is the best drug for one’s high blood pressure or best technology to further diagnosis a chronic or mental illness. I mean, who is the best physician who has garnered an incredible education, not only in acute and chronic care medicine, but also in health promotion, wellness, disease prevention, and alternative medicine, which in many cases should no longer be “alternative”, but a mainstay of how we care for our children, adult and elderly populations. Such well-rounded care is not happening in our U.S. health care system. Yes, some changes have been made regarding how we train our clinicians, however, it is occurring at an incredibly slow pace, with no national mandate, until recently, with this version of a progressive health care policy we define as Obamacare or the Affordable Care Act.

    We not only have a shortage of physicians, overall, but also disproportion. There are too many physicians in some locations and not nearly enough in other communities and regions of the country. Furthermore, a physician in the U.S can either be trained in allopathic medicine or osteopathic medicine. The thought, decades ago, when these two lines of training developed, was that one would be demonstrated to be more effective then the other or provide a better, more holistic level of care–this has not happened. Only in America… We now have nurses, nurse clinicians, and physician assistants doing the work of the physician, which may be fine, but as a nation we have not moved in declaring any major change in how we deliver health based on these new levels of heath care personnel. In fact, when you show up in a physician’s office thinking you are going to get “your physician,” there is a growing likelihood you will not, unless, of course, you are a prominent physician or wealthy or both.not happening in our U.S. health care system. Yes, some changes have been made regarding how we train our clinicians, however, it is occurring at an incredibly slow pace, with no national mandate, until recently, with this version of a progressive health care policy we define as Obamacare or the Affordable Care Act.

    So, Senator Cruz and politicians on both sides of the fence really do not get “how to get to better health” and appear not to be making an honest and ethical effort to do so. We have much to do, requiring a significant amount of courage, honesty, integrity and intelligence. Redefining the role of the U.S. physician and providing better training to our medical students and residents to enhancing the mission of our hospitals will demand these characteristics.

    What we need to do now is at least get those citizens who do not have insurance into a health care system, even though that health care system is broken. We cannot let the poor and other uninsured citizens wonder out there with nothing. We cannot allow our newborns to suffer a higher mortality rate than newborns in most other industrialized countries, simply because their mothers do not have access to some national health care system. We cannot keep abusing our emergency rooms with illnesses and health issues that can be dealt with in some national health system even though it is broken. This is what Senator Cruz and the great majority of our politicians, who very much have the best health care in the world available to them, simply do not get. So, let’s “correct and enhance”, as many other countries have done from generation to generation, rather than tear down and allow others to fall victim, once again, to our politicians uncaring, dishonest, unethical and indecisive behavior.