Matt Masiello, M.D., MPH

Category: International Health Promotion

  • 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

  • About Dr. Matt


    Matthew G. Masiello, M.D., MPH, FAAP

    Dr. Masiello holds the position of Clinical Professor of Pediatrics at the University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts; Chief, Pediatric Hospital Medicine and Interim Chair of Pediatrics at Health Alliance Hospital , Leominster, Massachusetts. In addition, he will soon be taking on the positon of District 9 Represenative for the Massachusetts Chapter of the American Academy of Pediatrics.

    Dr. Masiello’s work in the care of children has been in the role of a critical care physician, general practitioner, Chairman of Pediatrics and Vice-President in a large health care system, public health research scientist and public health program director. This has afforded him the opportunity to lead clinical and public health teams in the support, development and implementation of a multitude of evidence based, clinical/health promotion initiatives, both nationally and internationally. They include numerous school, hospital and community based projects such as clinical health promotion initiatives for the pediatric asthma population; medical home development; worksite wellness programs, community need assessments, program evaluation services, coordinated school health council development, child and adolescent bullying prevention; childhood obesity and injury prevention initiatives. Many of these efforts were reviewed in the manuscript, A Health Promoting Hospital: A Strategy in the Re-Design of the U.S. Health Care System. Commonwealth: A Journal of Political Science. Special Policy Issue on Public Health. Vol. 14, No.1. Dec. 2008, developed to address the issues related to the public health system in Pennsylvania. This community, regional, national and international health promotion work has been awarded over $ 7 million to date.

    His work in population health has also been at an international level. He served as a U.S. Network Coordinator for the International Health Promoting Hospital Network (HPH), a World Health Organization supported Collaborative Centre. From 2010 to 2012 he served on the Governance Board of HPH.

    Dr. Masiello has had the opportunity to present his work nationally and internationally through peer review journals, reports and national presentations. In 2012, he was awarded the Pennsylvania Public Health Association Keystone Award for Distinguished Service in Public Health. Other awards of note have been the SAFE KIDS 1996 Physician of the Year, Allegheny County Safe Kids Coalition, Pittsburgh, Pennsylvania, May, 1996; the Champion Award, Hospital Council of Western Pennsylvania, Pittsburgh, Pennsylvania, November, 1996 and the American Trauma Society, Pennsylvania Division, Hershey, Pennsylvania, May, 1995.

    Dr. Masiello has taught at the undergraduate (public health for physicians’s assistants) and graduate level (Delivering Health Care in America – A System’s Approach). He has served as a consultant to school systems, colleges, universities, health systems and clinical sites in such areas as developing undergraduate public health curriculum; becoming a WHO recognized health promoting hospital and developing medical home activities within pediatric clinical practices. From an international research perspective he has collaborated with colleagues at Spedali Civili, the third largest health care system in Italy and the University of Brescia, Italy by serving as co-director on a child asthma, clinical health promotion initiative.

    Dr. Masiello’s international work has been both humanitarian in nature as well as research oriented. He has supported and led clinical/educational teams and/or served as visiting faculty in Mexico, Indonesia, Nicaragua and Anguilla. These activities have ranged from providing medical care for the indigineous pediatric population in the Sierra Madres, Mexico; to developing critial care services for children suffering from Dengue Fever; to providing general pediatric and critical care support for the survivors of Hurracaine Katrina and the Indonesian Tsunami. For the latter, he received a 2005 President’s Volunteer Service Award by the President’s Council on Service and Civic Participation.

    The Amerian Public Health Association has published and the CDC and the Robert Wood Johnson Foundation have endorsed, The Public Health Approach to Bullying Prevention. Dr. Masiello serves as co-editor. Dr. Masiello has served on a National Academies of Science, Engineering and Medicine committee to address the biological and psychological effects of peer victimization. The report, Preventing Bullying: Through Science, Policy and Practice, was recently published as the latest evidence based comment

    Offering the latest recommendations to address the public health epidemic of child and adolescent bullying.

    Additional interests, resulting in media releases, educational and industrial briefs, have been in the areas of child human rights in which he serves on an international task force: Think and Action Tank (TAT) on Children’s Right to Health, Translating the Principles of Child Rights into Practice, A Rights and Equity based Platform for Child Health and Well-Being, based in Bologna, Italy; the benefit of an “Enhanced Development of the U.S. Rail System: An Economical and Health benefit to Society;“ safe schools; firearm injuries in children and childhood obesity.

    In addition to Dr. Masiello’s international medical degree his pediatric medical training was at Bridgeport Hospital and Yale University with a pediatric critical care fellowship at Harvard University, Boston Children’s Hospital. His master’s degree in public health was earned at the George Washington University School of Public Health and Health Services.

    The Masiello’s reside in Harwich, Massachusetts. Kathy is a school nurse and fitness instructor. Jason is a Junior at Monomoy High School. Matt, the oldest son, is a research assistant at the National Academies of Science, Engineering and Medicine, Washington, D.C.

    Contact information:

    DrMatt@MattMasielloMD.com
    814-619-6168ż
    Twitter: ​@MattMasielloMD
    Blog: ​MattMasielloMD.com

  • More About Dr. Matt

    AmazingKidslogoMatthew Masiello, MD, MPH, FAAP
    Chief Medical Officer
    Specialty: Pediatrics
    Appointments and Referrals: 412-420-2371
    Biographical Summary:
    Matthew G. Masiello, MD, MPH, FAAP serves as Chief Medical Officer and Medical Director of Care Coordination at the Childrens Institute of Pittsburgh. He also maintains his position as the Director, Center for Health Promotion and Disease Prevention (CHPDP), located in Windber, PA.
    Dr. Masiello has led his clinical and public health teams in the support, development and implementation of a multitude of evidence based, clinical/health promotion initiatives. These programs now extend throughout Pennsylvania, nationally as well as internationally. They include child bullying prevention, clinical health promotion initiatives for the pediatric asthma population, childhood obesity and injury prevention initiatives, medical home development, worksite wellness programs, community need assessments, program evaluation services, and coordinated school health council development.
    Dr. Masiello has had the opportunity to present his work nationally and internationally through peer review journals, reports and national presentations. In 2012, he was awarded the Pennsylvania Public Health Association Keystone Award for Distinguished Service in Public Health. Other awards of note have been the SAFE KIDS 1996 Physician of the Year, Allegheny County Safe Kids Coalition, Pittsburgh, Pennsylvania, May, 1996; the Champion Award, Hospital Council of Western Pennsylvania, Pittsburgh, Pennsylvania, November, 1996 and the American Trauma Society, Pennsylvania Division, Hershey, Pennsylvania, May, 1995.
    In addition to Dr. Masiello’s international medical degree his pediatric medical training was at Bridgeport Hospital and Yale University with a pediatric critical care fellowship at Harvard University, Boston Children’s Hospital. His master’s degree in public health was earned at the George Washington University School of Public Health and Health Services.
    #MattMasielloMD

  • Enhanced Development of the U.S. Rail System: an Economical and Health Benefit to Society

    We have developed a research brief entitled, Enhanced Development of the U.S. Rail System: an Economical and Health Benefit to Society ” which serves as an overview of the consequences of inadequate rail service in the U.S. Furthermore, this brief was designed with politicians, business leaders, academic institution, and American citizens in mind given the all-encompassing benefits of a faster, wide-spread rail system.

     


    #MattMasielloMD

  • After the Volcano

    Another year and we find ourselves not only going back to Europe but being asked to go back. Having a World Health Organization Collaborative Center doing the asking is not a bad deal. Next week Mr Tom Kurtz, our CEO at the Windber Research Institute (WRI) will be leading a five person entourage from Pennsylvania to the World Health Organization Health Promoting Hospital Conference in Turku, Finland. This team will consist of Mr Kurtz, Dr. Carla Zema from St Vincent University, Barbara Adons, RN from St Mary Medical Center, Ms Charvonne Holliday and myself from WRI. Spending an extra week in the UK last year due to mother nature was certainly an event, especially for my 17 year old son who most definitely benefited from that academic and environmental experience. Some ground shaking work will be in the offering this year but hopefully, and only, from our own doing.

    20120517-163251.jpgAs these large international conferences go the plenary session is a key event where all of the participants, 500 in this WHO event, are expected to attend. Charvonne Holliday and I are preparing a presentation that will allow this esteemed audience to hear about the work our WRI team has done in the area of violence prevention. Over the years we have been successful in identifying funding for our community based projects due to our compulsive nature to evaluate and monitor what we do. The alternative to that at times and unfortunately is to fund a program, offer the program to the community but never fully or appropriately evaluate all the steps in that process. For the first time in the 19 years of this conference there will be a 2 hour workshop on just how to do that. The scientific committee of the organization has asked the Pennsylvania based group to be that scientific team doing the honors for this international group of hospital and health service administrators, public health professionals and health care workers.

    I have once again been asked to present our work at one of the break out sessions. Here we will talk about our collaborative project with one of the largest health care systems in Europe, Ospidal Civili. Per the invitation of this hospital I will have the opportunity to spend a week in Brescia, Italy prior to the WHO conference preparing this presentation and advancing this pediatric asthma clinical and health promotion project. While in Italy I will also be traveling to Padova where I will have the opportunity to present our bullying prevention work to the Psychology Dept at the University of Padova. This Center and the Windber Research Institute have been collaborating in determining the health effects of bullying and the cost benefit to prevention programs.

    And as I did last year, I will be moderating a session where several hospital and health system leaders will present their programs to that interested group of colleagues. In a similar session The Italian University and WRI will be presenting our collabotrative work on developing a pediatric clinical/health promotion data base.

    As we did at the Windber Research Institute and the Windber Medical Center several years ago, Tuku will be holding a event similar to our WHO Winter School, but this time in sunny Finland. Here, I will have the opportunity to teach new members of this 700 hospital organization about the Health Promoting Hospital Network and our many other projects, including the Windber and Copenhagan health promotion project which is about to be published. Lastly, I have the privilege to represent the United States and Pennsylvania at the Governance Board meeting of the organization.

    All of this is funded though our Pfizer grant as well as stipends we will receive from the World Health Organization Health Promoting Hospital organization and our Italian colleagues. Wish us well. We will do Pennsylvania proud. Baring any volcanoes we will be back June 5th to report on a successful journey.

  • Local experts weigh in on health-care reform

    20120517-164136.jpgLocal medical leaders are closely watching health-care reform legislation developing in Washington. While most agree with the importance of providing affordable options to the estimated 45 million to 50 million uninsured Americans, they have different views on how the insurance should be structured and what additional changes should be addressed.

    “The question is: How are we going to pay for that expanded coverage?” said Scott Becker, president and chief executive officer of Conemaugh Health System. “The real interesting debate is going to be how far do they go with this public option. The key is how the benefits package is shaped.” Answers to those questions could change the structure of how health insurance is delivered in the United States, Becker said.

    The public option, or government-sponsored health care plan, would be available as an option along with private insurance company plans, Democratic Sen. Robert P. Casey Jr. said during a teleconference announcing one of the bills had been approved by committee and sent to the full Senate.

    In the Health, Education, Labor and Pension committee’s bill, the public option is a gateway to getting access, Casey said, adding it is expected many would move on to traditional private plans. But the public option is crucial to controlling costs. “I believe big, powerful insurance companies need to be held accountable.” Casey said. Under the committee’s bill, the gateway program would be launched with federal money but managed by a nonprofit cooperative, he said. “It’s meant to be a self-sustaining entity that can be competitive in the marketplace,” Casey said.

    While any government-funded health insurance is meeting stiff opposition from Republicans, none of the local experts interviewed was ready to totally dismiss the idea. “I think the good thing is we are trying to develop coverage for 45 million people who don’t have insurance”, Becker said. “It is going to create a level playing field, but you are not going to get that for nothing.”

    The final structure of a new public option will be developed after both the House and Senate pass bills and they are sent for reconciliation. Until then, Conemaugh is taking a wait-and-see attitude. “As they say: The devil is in the details,” he said. Lack of details has many in the insurance industry worried, Highmark spokesman Michael Weinstein said. Government insurance plans such as Medicare and Medicaid have traditionally paid physicians and hospitals less than private companies.

    “There is a natural advantage to government-run plans: They dictate the payments to doctors and hospitals,” Weinstein said. “It is going to drive up the cost.” If the government-funded plan does not pay enough to cover expenses for hospitals and doctors, he said, the medical organizations will shift those costs to private plans such as Highmark. As those rates go up, insurance companies fear more employers will drop private plans and put their workers into the government plan. Bringing down costs must be part of any plan. Highmark supports a plan that would base payments more on outcomes, Weinstein said. “We haven’t seen enough debate on this: How doctors and hospitals are paid,” he said. “The way Medicare works, the more tests a patient has, the higher the cost. It doesn’t guarantee better outcomes.”

    Some local preventive medicine advocates agreed that reform should include restructuring the way doctors and hospitals are reimbursed. “The good thing about the discussion is we are going to look at policy change,” Dr. Matthew Masiello, chief wellness officer, said from Windber Research Institute. “It opens up the doors with universal health care to look at policy we have not dared address in a serious way before. ”Smoking, obesity and nutrition can be addressed by adding financial incentives for physicians who direct patients into programs that help them overcome unhealthy habits”. Although Casey said his committee’s bill addresses preventive medicine and wellness, Masiello says all the proposed reform falls short.

    “I see very little in there to support developing a substantial health-promotion, disease-prevention infrastructure,” Masiello said. “For that reason we are going to see higher cost of health care until we develop significant infrastructure.” Adding 45 million to 50 million people to the insured “pool” will be expensive, especially because many of those uninsured have chronic conditions that may be undiagnosed because they haven’t been seeing doctors.

    Windber Research Institute is part of a study using electronic medical records to identify patients with unhealthy behavior and direct them into intervention programs. “Those kind of things should be on the front burner,” Masiello said. “Down the road you are going to get the results that will allow a reduction in the cost of health care.” The research institute’s top dog is more blunt. “This isn’t health-care reform,” said Tom Kurtz, Windber’s president and chief executive officer. “It is misnamed. They are going after an insurance product.” The 45 million or more people are just a symptom of a larger issue, he said. “It addresses nothing of the underlying problems of the health-care system.” Kurtz said, adding it might even be time to ask why the U.S. health insurance structure is based on employers. Recent layoffs highlighted the issue. “They need to revamp the system,” Kurtz said. “No one has even addressed the basic questions: Is health care a right? Is it an entitlement? What should be covered?”

    Other countries have addressed many of these issues successfully, he said, adding “Japan is a good example.” But it’s tough to legislate behavior, Becker warns. Insurance companies could, however, charge higher premiums for those with greater health risks.

    For now, Congress and the health-care industry should look at focusing on improving access to primary care doctors, Becker said. The current system pushes more money toward specialists, but family physicians are the front line of prevention. “It’s a cultural challenge we face now,” Becker said. “We need to open up roads and create incentives for more physicians to go into primary care.” Like his former Windber colleagues, health-care consultant F. Nicholas Jacobs believes the reform does not go far enough. “Tort reform, intelligent efforts toward stemming the continued surge of illegal aliens, a wellness rather than a sickness reimbursement system, acceptance of hospice and palliative care for end-of-life care, electronic medical records and new efforts to bolster our medical school attendance are just a few of the changes needed to allow health-care reform to gain meaningful traction,” Jacobs said in a statement.

    The former president and chief executive officer of both Windber Research Institute and Windber Medical Center worries that current proposals have been watered down too much to appease conservatives and others. “Health reform is critical,” Jacobs wrote.
    “But meaningful, ethical leadership is much more critical and both seem to have been on life support for a very long time.”

    **This article was published in the Tribune Democrat on July 19, 2009

    http://tribune-democrat.com/local/x914502174/Local-experts-weigh-in-on-health-care-reform