Posts Tagged ‘Chronic Diseases’

Growing Inequality in Health and Life Expectancy Between Nations

April 4th, 2015 at 3:57 pm by timigustafson

April 7 is World Health Day, an annual event sponsored by the World Health Organization (WHO) to promote greater awareness of global health issues. Conferences and activities all over the world address diverse topics like life expectancy, infant mortality, spread of diseases, access to clean drinking water, healthcare infrastructure, to mention a few. This year’s main focus is on the growing threat of foodborne illnesses.

Life expectancy, in particular, has long been considered a leading indicator for progress or decline of public health, and many changes have taken place in this regard over time. However, the gap between the richest and poorest parts of the world in terms of health status and longevity remains wide and may not significantly narrow in the foreseeable future. For example, most African populations still fall many years short behind their European and North American counterparts.

An outlier turns out to be Qatar, which is now rated the healthiest country in the world, followed by Norway and Switzerland. Why Qatar? Although this relatively small country with a population of just over 2 million has no national healthcare system, easy and affordable access to medical services seems one of the distinguishing factors. With more than three physicians per 1,000 people, the country is better staffed with healthcare professionals than most others. By comparison, the United States has less than two and a half doctors per 1000 inhabitants, while Canada has about two.

Yet, the US is well known for having the highest medical expenditures in the world. According to Forbes, the annual per capita spending on healthcare here is well over $8,000. Canada spends a bit more than half as much.

What do Americans get in return for that kind of money? Unfortunately, a lot less than one would expect. Among 10 of the most developed countries, the US comes in dead last, behind Canada, Australia, New Zealand, and most European nations.

The most striking deficiencies are related to a convoluted healthcare system that is less efficient and less affordable for large parts of the population.

Inequality is a particularly pressing problem. According to the report on healthcare spending and based on data by the WHO, the US ranks clearly last on measures of equal access to healthcare.

“Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one third or more lower-income adults in the US said they went without needed care because of costs,” it said in the report.

By contrast, Canada was generally lauded for its universal healthcare system but also faulted for its high costs as well as timeliness and efficiency of care. High marks were given to Australia for quality and cost efficiency.

To turn things around, WHO experts recommend that policymakers in the respective healthcare systems combat first today’s fastest spreading health threats like lifestyle-related chronic diseases, a.k.a. non-communicable diseases (NCDs), including cancer, heart disease, and lung disease, largely through preventive measures like reducing tobacco use and dietary improvements.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

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Despite of the increasing prevalence of chronic diseases, a majority of older Americans find ways to manage life’s challenges and keep their independence, according to a study recently published in the American Journal of Public Health. Unlike most previous studies of this kind, this one tried to take a more nuanced approach to issues of age-related disability and dependence of assistance.

Age-related disability is commonly defined as a reduced capability of performing everyday activities like maintaining basic hygiene, getting oneself dressed, moving around without help, or other routines like shopping and cooking.

According to the study, which looked at 38 million older adults enrolled in Medicare, including residents of nursing homes, about 12 million (31 percent) were fully able to manage on their own without any assistance; 9 million (25 percent) successfully learned to cope with limitations by using devices like electric wheelchairs, walkers, canes, hearing aides, and by making other adjustments to their homes; about 2 million (6 percent) were unaware of or failed to acknowledge their diminishing independence; 7 million (18 percent) found it hard to keep functioning without support but tried anyway; and nearly 8 million (20 percent) relied on caregivers, with about 1 million living in nursing homes.

Those who took precautionary measures like downscaling their households and simplifying their living environment were considered “successful adapters,” while others who either struggled to get through their day or depended at least part-time on outside help were found at the greatest risk of losing their independence.

Most seniors fear the loss of independence and having to move into a nursing home more than death, according to several studies on the subject. A vast majority (89 percent) hope to die in their own home, and more than half are concerned about not being able to do so. Most also don’t expect or desire to receive support from their children or other relatives. Only 1 percent reported wanting or actually receiving financial aid.

On the other hand, especially now retiring baby boomers are very keen on utilizing technological advances like computers and other devices and appliances in their homes to maintain an independent lifestyle.

But despite of such unprecedented opportunities, health concerns do weigh heavily on today’s seniors. Because of rising rates of chronic illnesses such as obesity, diabetes, heart disease, high cholesterol, high blood pressure, and others, older Americans are actually less healthy than the generations that came before them. This may have potentially devastating consequences for how well they age, and so far the signs are not encouraging.

Other leading health concerns for the elderly include arthritis, osteoporosis, respiratory problems, and of course, cognitive decline like memory loss and Alzheimer’s.

The good new is that at least some of these trends could be turned around through better diet and lifestyle choices, and for implementing those, it is never too soon or too late. It would be surprising if Americans who have the most to lose could not find ways to protect what’s dearest to them.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

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It is a widespread belief that the aging baby boomer generation is going to break the bank when it comes to medical costs. But while it is true that the elderly on average have greater healthcare needs than younger people, it is not where the bulk of the money goes, according to a recent study published in the Journal of the American Medical Association.

There are mainly two factors that make the American healthcare system more expensive, albeit not more efficient, than any other in the world, the study found. One is that the costs of medical and administrative services as well as drugs and devices have risen astronomically over the last decade or so. The other is that treating patients with chronic diseases like diabetes and heart disease is expensive, no matter what their age is. In fact, the majority of those suffering from these illnesses is under 65.

Paradoxically, today’s healthcare consumers pay a much smaller percentage of the actual costs to the system than they did 30 or 40 years ago – about 11 percent compared to 23 percent in the 1980s. That also means that most people don’t have the slightest idea how expensive medical services are because they never see 90 percent of the bills, says Dr. Hamilton Moses, chairman of the Alerion Institute, a consulting firm in Virginia, and a professor of neurology at Johns Hopkins University who wrote the study report.

The other issue is the sharp increase in diet and lifestyle-related diseases, which are now affecting ever-larger parts of the population. In 2011 (the year of the most recent numbers available), treating chronic illnesses absorbed 84 percent of all medical spending, two-thirds of which went to patients younger than 65 years of age.

“Chronic illness is a problem for everyone, not just the elderly,” says Dr. Moses. “That’s another reminder to follow a healthy lifestyle to reduce your chances of developing common health problems like high blood pressure, high cholesterol and diabetes.”

Unfortunately, our current system with its almost exclusive focus on treating existing health problems instead of preventing them is not well equipped to address these challenges.

“There are lessons to be learned from other countries,” says Dr. Moses. Chronic illness is where the misery is, it is where the money is, and it is where the greatest opportunity lies.”

A recent memo issued by the Centers for Medicare and Medicaid Services (CMS) points in that direction. In it, the agency urges doctors to include “intensive behavioral therapy” for obese patients in their treatment, meaning more screening for weight problems, nutritional assessment, and counseling on diet and exercise. Unlike in the past, the CMS says it will authorize reimbursement for this kind of counseling sessions from here on.

Similarly, the American Heart Association (AHA) has called for medical service providers to evaluate their patients’ physical activity habits as routinely as they check blood pressure and other risk factors for cardiovascular diseases.

Recommending measures like these are geared towards prevention and that can be a good first step, acknowledges Dr. David L. Katz, director of the Yale University Prevention Research Center. Unfortunately, most doctors are not well versed in weight management counseling, partly because it is still not a subject matter that medical schools spend much time on.

“Bad counseling can be worse than none at all,” he writes in an opinion piece in the Huffington Post.

Still, enlisting doctors in the fight against the obesity epidemic can be a good start if it leads to a comprehensive solution that goes beyond their practice. In any case, it is better to make the current system part of the solution instead of the problem.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

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Lifestyle-Related Ills Tend to Multiply with Age, Study Finds

April 24th, 2013 at 7:13 am by timigustafson

Seniors who suffer from chronic health conditions like high blood pressure or heart disease often develop a host of other, seemingly unrelated health problems, including cognitive impairment like memory loss and dementia, according to a new study based on data collected by the National Center for Health Statistics.

For the study, the researchers analyzed the medical records of hundreds of thousands of seniors residing in assisted-living facilities and found that most had at least one chronic health condition. What was more alarming, however, was that many had overlapping ailments. While high blood pressure and heart disease were most common, nearly half of the assisted-living residents showed signs of dementia.

“These findings suggest a vulnerable population with a high burden of functional and cognitive impairment,” the authors of the study report wrote.

Many studies have suggested a link between vascular disease and dementia, particularly Alzheimer’s, said Dr. P. Murali Doraiswamy, a professor for psychiatry and behavioral sciences at Duke University’s Institute for Brain Sciences (DIBS). Therefore it may not be possible to treat dementia without treating vascular problems, he added.

But that may be easier said than done. “We don’t universally do a great job of how we treat conditions that overlap, for example Alzheimer’s and high blood pressure,” said Dr. Cythia M. Boyd, an associate professor of geriatric medicine at the John Hopkins University Center on Aging and Health, to the New York Times. “Much of the way we practice medicine is looking at disease by disease. We aren’t doing enough thinking about how to add them together and really integrate care.”

What makes things more complicated is that most doctors are not sufficiently trained in preventing or reducing lifestyle-related illnesses – not in the general public and certainly not in older patients – other than through medicating. For instance, the importance of nutrition as a part of preventive care is rarely ever mentioned in medical schools. The approximate time devoted to nutrition science over the first two years of medical education is six hours, which is clearly inadequate, according to the National Academy of Sciences. The same goes for other health-promoting measures such as exercise, especially for the aging population.

Yet many studies have provided compelling evidence that diet and exercise play a significant role for physical and mental health at any time in life but increasingly so as we age.

For example, a more recent study from Britain concluded that the so-called “Western diet,” which typically includes fried, sweet and processed foods, red meat, refined grains and high-fat dairy products, increases the risk of chronic diseases, which in turn can adversely affect both physical and mental health in later years. Eating a Western diet makes it less likely to have an ideal aging process, says Dr. Tasnime Akbaraly, a researcher at the University College of London and lead author of the study report. Conversely, making dietary improvements can yield multiple benefits in this regard.

There is also further evidence that exercise can give a boost to the aging brain. Scientists at the University of British Columbia found that older women who suffered from mild cognitive impairment could improve their memory through weight training and brisk walking.

The connections between physical and mental decline may not yet be completely understood, but it seems clear that chronic diseases play a major role in the process. While these are widespread, the encouraging news is that many, if not all, are preventable by healthier lifestyle choices.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

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The World Health Organization (WHO) has set a number of targets for reducing so-called non-communicable diseases (NCDs) by 25 percent by 2025. NCDs are chronic illnesses largely caused by dietary and lifestyle factors. They include obesity, heart disease, diabetes, some types of cancers and chronic respiratory illnesses that combined have become the leading causes of death globally, according to the agency.

Chronic diseases account for 36 million deaths annually, over 60 percent of all human mortality. They continue to accelerate globally and are advancing across all regions, affecting all socioeconomic classes. It is expected that almost three-quarters of all deaths will be caused by chronic diseases by 2020.

Chronic diseases are defined as illnesses of long duration and generally slow progression. They are also considered as largely preventable by positive dietary and lifestyle changes.

One of the leading causes is obesity, which has doubled worldwide since 1980. Weight problems are the fifth leading risk factor for all deaths. At least 2.8 million adults die each year as a result from being overweight. In addition, 44 percent of diabetes rates, 23 percent of heart disease rates and up to 41 percent of cancer rates are attributable to weight problems. Obesity is now linked to more deaths worldwide than underweight.

Especially worrisome is the continuing rise of childhood obesity. In 2010, more than 40 million children under the age of five (!) were overweight. Almost 35 million of these live in developing countries. Most impoverished children who have weight problems are also severely malnourished.

Leading causes of unhealthy weight gain are poor diets based on energy-dense foods that are high in fat, salt and sugars but low in nutrients. A worldwide decrease in physical activity due to sedentary lifestyles, increasing urbanization and changing modes of work and transportation also plays a role.

To change the current trends, improvements must take place on several levels, according to WHO recommendations, including individual responsibility, education, social environments as well as quality and affordability of food supply. “Individual responsibility can only have its full effect where people have access to a healthy lifestyle. Supportive environments and communities are fundamental in shaping people’s choices. The food industry can play a significant role in promoting healthy diets by reducing fat, sugar and salt content of processed foods, ensuring that healthy and nutritious choices are available and affordable to all customers and by practicing responsible marketing.”

The “WHO Global Strategy on Diet, Physical Activity and Health,” which was first introduced by the World Health Assembly in 2004, calls for actions needed to support healthy eating habits and regular physical activity. The agency “calls upon all stakeholders to take action at global, regional and local levels to improve diets and physical activity patterns at the population level.” For this, an action plan was developed for the prevention and control of NCDs as a roadmap to establish and strengthen more initiatives on local, national and international platforms.

Although the targets set by the WHO are not binding and lack in many ways specificity, similar initiatives have shown some degree of effectiveness in the past. For instance in 1987, the World Health Assembly created the first “World No Tobacco Day” to draw global attention to the health effects of smoking. It is commemorated every year on May 31 as an occasion to help reduce worldwide tobacco use. In 2005, the agency released the “Framework Convention on Tobacco Control” (FCTC) with similar goals.

Tobacco use is still the second most common cause of death in the world, after hypertension, being responsible for killing one in 10 adults every year. Obviously, we have a long way to go, but progress has been made. Hopefully, WHO’s continuing efforts will increase awareness of the seriousness of chronic diseases as well.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

 

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About timigustafson

Timi Gustafson, RD, LDN, FAND is a registered dietitian, health counselor, book author, syndicated newspaper columnist and blogger. She lectures on nutrition and healthy living to audiences worldwide. She is the founder and president of Solstice Publications LLC, a publishing company specializing in health and lifestyle education. Timi completed her Clinical Dietetic Internship at the University of California Medical Center, San Francisco. She is a Fellow of the Academy of Nutrition and Dietetics, an active member of the Washington State Dietetic Association, a member of the Diabetes Care and Education, Healthy Aging, Vegetarian Nutrition and the Sports, Cardiovascular and Wellness Nutrition practice groups. For more information, please visit http://www.timigustafson.com

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