Saturday, August 02, 2003

Worried about cholesterol? Worried that you cannot afford the drugs that you think that you need? - Don't worry be happy! Here is another view from the Whitehall study. What is shows are the rate of death from Coronary Heart Disease (CHD) your rank in the hierarchy and the risk factors. Look to the right at the longest bar chart. This shows that you are 4 times more likely to die form CHD if you are at the bottom of the pile than at the top. See that thin black line at the foot of the chart - that is your risk factor to scale if you have high cholesterol. yet what is the main topic of your conversation with your doctor? What are the best selling set of drugs, after anti deprressants? Pills to lower your cholesterol. The blank in the file (actually white so it doesn't show) is high blood pressure. Taking pills for hypertension? Even smoking is not too bad. It's easier for us to take a pill I suppose than to face reality about our lives. Are we mainly slaves or free - that is the health question I think. There is no doubt that many drugs are very useful but are the the only way to see health improvments? I love this slide. It shows the relative decline of TB. Most of the battle was won in the public health sector way before the introduction of antibiotics in the 1950's. How we feel about ourselves is another important factor. Here we see the amazing rise in the crude death rate in Russia after the collapse of the Soviet Union. What is the main factor. A loss of identity. We see the same prcess in our native population in North America. So what's my point? One of the factors that is causing our healthcare costs to exceed the rate of groweth of our economy is the rising cost of drugs. We seem to belive that it is only drugs that keep us from death's door. This is especially true for seniors. How do we change this perception?   4:38:19 PM    comment []

More of my thoughts - What is really Going On? When I left CIBC nearly 10 years ago, my intention was to write a book. It was going to be about the nature of the change that confronts us. In a way, I am disappointed that I have not written it. But perhaps most of what I want to say is in my other website, Renewal, which I have today attached to the blogroll. These articles are partly excepts of reports that I have written, some are articles that I have published in magazines and some are from books where I have contributed a chapter Here are the main topics: Change Dramatic change in assumptions and beliefs have occurred before. What is the pattern and what are the drivers? What can we predict? Individuals  At the centre of change is of course us. How can we look at ourselves with fresh eyes? How do complex new theories about physics that concern the very small or the very large affect us as people? How do we become centred? What does the older wisdom tell us that will help us find our way? Organizational Design What is the new organization model? Who is doing it now? What are the new rules? What is power? What is the new relationship between the individual and the group? Business What is behind our perception that business and the planet cannot coexist? Is there a better way? Government Why does government not work well any more? What is the flaw of the "Service Model"? What is an alternative model? Food Why is it that how we get our food is at the heart of any human culture and belief system? Why is agriculture and food at the core of our environmental crisis? What is behind our fears about food safety? Why do we need to look beyond the farm for answers? When you look deeper into the site you will see many more subcategories and links 3:59:34 PM    comment []

Identity - Our most important need? Does blogging make you well? I was struck this week by seeing "Augustine's wall". In the work I am doing on health, I have come to understand that one off the most powerful negative forces on our immune system is when we lose our sense of control and identity. The modern bureaucracy strips us of both. Hence now 17% of payroll is the direct costs of absence and health in the modern workplace. Just before you scan on past this -17% OF PAYROLL!!!!. Most disease in the developed world is chronic. Diabetes, back problems, depression. They cannot be "cured" by using the germ theory.  This type of disease is the largest cost in the modern work force and is also driving the revenues of the drug companies who have found a gold mine in problems that cannot be "cured". Drug cost are rising at a compound rate in excess of 9% and will move soon to the top of the list of costs in the health system. But actually it is Augustine that has a sense of where we could more profitably look for help. The emerging key to chronic disease is culture. Our immune system is compromised when we live in a culture where only a few have voice and control - the modern bureaucracy. We are also learning that the same conditions apply when we look at societies. Those that are very top down such as Sicily have much worse health and economic outcomes that say the north of Italy that has a tradition of strong horizontal links of self help. We are also learning that the same is true in families as well. Egalitarian family cultures drive the best development for their children. All this is coming together in a grand theory of culture/the immune system/development and coping. Here is Sir Michael Marmot, the world's leading workplace researcher on the topic: The question is what is it about position in the hierarchy that determines different rates of disease?   And given that, the hierarchy in disease does change. All societies may have hierarchies but we know that the social gradient in disease is not fixed. It?s bigger in some places than others and it can change over time. This could be that the magnitude of the hierarchies change, but there are always hierarchies. But more importantly, it suggests that it is about where you are in the hierarchy that's related to disease and can we do something about that?   So you ask is it money? Is it prestige, self esteem? And in fact what I think it is has much more to do with how much control you have over life circumstances and the degree to which you?re able to participate fully in society..?   Here is what this means in real life. Here is a graph showing the Gradient in mortality in the Whitehall Study that looked at the UK Civil Service over 20 years. In the UK, Administrative would be the top of the heap. People at the bottom have 4 times worse outcomes. These forces are much more powerful that the factors that we currently focus on such as smoking, obesity etc.   Putnam makes the same case for the impact of community on health as well.   The traditional "paternal cultures" such as Louisiana are at the bottom where only those at the top feel they have a voice and control, and the more egalitarian cultures such as Vermont are at the top where many feel that they are in charge of their lives and that they have a say. Again these indentity and control forces are huge.   Wilms at UNB has found the same correlation in family culture as well. Those families with very traditional authoritarian cultures shut down their children and set them up for very poor development tracks. By the way really permissive parents are almost as bad.   Augustine is so on the money! My sense is that in the next 20 years we will develop an approach to health that is largely governed by our emerging understanding of how our immune system is connected to our sense of identity and voice. Paradoxically, similar "Public Health" approach in the late 19th century hit infectious diseases on the head. Clean water, good sanitation, the end of child labour, the introduction of public schools etc all contributed to a huge reduction of infectious disease well before the introduction of anti biotics. I find it interesting that as parts of society break down that diseases such as TB are on their way back now.   My hope is that as we understand the issues of control and voice, that we can shift from medication to having a better life as the "cure". 9:49:52 AM    comment []