Entries for the ‘What the future of health looks like’ Category

What is “public health” anyway?

Monday, March 1st, 2010

copy-of-p3061598March 1, 2010

As children begin to know about roles and jobs, some will say, “I want to be a doctor.” Their parents buy them a ‘doctor’ kit to play with, and they practice being a doctor. I never hear a child say, “I want to work in public health.” Why is that? What’s wrong with this picture?

Public health isn’t part of the usual high school curriculum, so we don’t get an introduction to what a career in public health might look like. When health education is taught in high school, the course doesn’t introduce students to the public health system. And so, not surprisingly, few of us know what public health is or what the public health system does. 

Public health often treats health as a public good. A public good is something for which the benefits for one of us cannot be separated from the benfits for ‘all’ of us. When I get a flu shot, I am supposed to benefit by not getting the flu. But others benefit because they do not get exposed to the flu from me. 

So monies spent to inspect restaurants or public pools benefit every member of the public who eats at the restaurants or uses the pools, not just one of them. Monies spent for newborn screening programs benefit all of us because we identify conditions at early stages when prevention or care may limit the harm, and all of us benefit by having a friend or neighbor who can be a healthier and more productive citizen.     

School vaccines. Programs for reproductive health. Collection of data about births and deaths–vital statistics that can show patterns and be used to suggest how to improve birth outcomes and decrease deaths. Cancer registries. Programs to prevent disease and accidents. All of these and more are prt of public health’s efforts to promote the public good.

Is the public good “good” for me? Often it is. Sometimes, it may not be.

There are limits to what vaccines I want to be used as gatekeepers to my employment. But there are even more limits to what genetic tests I want to be used as gatekeepers to my free choice to pursue life paths. So the first step is to become aware of what public health means what public does. Then we can advance agendas relating to support for public health and guidelines about where to draw the line in the name of promoting the public’s health.

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Do we want doctors to tell us if we have advanced cancer?

Thursday, February 18th, 2010

117_1755February 18, 2010

In 2002, Hisako Kakai published an article in the journal, Health Communication, about preferences for disclosure of a cancer diagnosis. Dr. Kakai indicates that in Japan, a direct communication style is usually preferred when it comes to disclosing one’s personal diagnosis of cancer. In other words, people want to be told they  have cancer. However, an indirect communication style with no disclosure, or an ambiguous disclosure to the patient was preferred for a family member. The article raises many interesting communication and ethical issues.   

A serious diagnosis raises the question, ‘how do we deal with uncertainty?’ Communication plays a big role. It points to the reality that we often are not good with dealing with uncertainty. We frame uncertainty as ‘bad’ and let uncertainty overtake everything good that might be going on in our lives. This relates to how we communicate about a serious health condition. It also relates to how we communicate about the economy, about security, and about an endless number of issues that equal being — human.

The message communicated often to us is, ‘work hard and it will pay off’ — with payoff crossing a spectrum from health, relationships, and wealth. The message, ‘life is uncertain. Work hard at your relationships and school and work, and take satisfaction in the fact that you worked hard’ — is communicated less often, if at all. And it shows up in our inability to deal with uncertainty, our obsession with …reducing the uncertainty.    

Should the goal in communicating be to reduce uncertainty? When it comes to our health, that may not always be the best aim. If we can learn to manage the uncertainty of a diagnosis, we may be better able to live our lifes as someone living with cancer or heart disease or diabetes. If we make the diagnosis a more integral part of our being and identity, we may communicate in ways that define us to others as being disabled rather than living with a disability, diabetic rather than managing life while living with diabetes, and so on.  

Even more surprising, when we focus on managing our uncertainty as a part of life, we may even discover that there are times when we communicate to increase uncertainty. Instead of being certain that our future, our health, our well-being are uncertain and that is a bad thing, we can use uncertainty as a way to promote hope. In our own research, Ben Cairns and I found that this was particularly important for people who have newly experienced spinal cord injuries and their family members. ‘Will she walk again? Will he be able to do things for himself? Can she sit up on her own? Can he feed himself?’ Not knowing offers people living with the injury and their families and friends the hope that they might do these things again. 

Communicating to increase uncertainty about a diagnosis thus gives some time to adapt to a diagnosis. And that may be the best and more ethical way to communicate about an advanced cancer diagnosis as well. Not telling so that a patient does not know a true diagnosis may seem to offer a way to manage a serious diagnosis and thus to reduce uncertainty. Telling and acknowledging that the diagnosis is serious, even very serious, but that predicting exactly when the end-of-life will happen is uncertain may give some time to adapt to the diagnosis and some hope that important things that have not been said can be…

…a lesson in Dr. Maureen Keeley’s award-winning book, Final Conversations that has been shown to be so important for those who know that they are dying and the loved ones they will leave behind.

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How do you talk to your kids about sex?

Thursday, January 21st, 2010

roxgrace-beach_1370aJanuary 21, 2010

How odd that we have such difficulty talking with our kids about things that are so important. Why is that?

For one thing, it might lead to questions we can’t answer. Once we open the door with a toe halfway wedged, we know we shouldn’t be surprised if we get asked questions. We might not be able to answer questions because we don’t know the answers. They just might be asking about technical stuff that relates to science and biology, and we might not know. So, agree to find the answers. If your child is of an age where it seems appropriate, find the answers together.

Another thing that happens, of course, is that we want to save face–for us and for them. We don’t want to appear to fail to practice what we preach, whether it is having engaged in premarital sex or failing to protect ourselves from sexually transmitted infections. And we just know that if it sounds like we are trying to control our kids’ behavior, they won’t like it anymore than we do when sometimes tries to control us.

So, how do you do it–talk with your kids about sex? Listen. What do they have to say and what are they asking you? That is the part of talking that we so often forget…listening.

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Why should you talk about family history and health?

Tuesday, January 12th, 2010

roxannebuggyJanuary 12, 2010

The woman on the horse is a relative that I share a first name with…tho, of course, I never knew her. I wonder what else we might share. Hair color, height, health?

 The U.S. Surgeon General advises us to ‘know our family health history.’ The problem is, what to know and how to know it. Since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day [http://www.hhs.gov/familyhistory/] as part of an initiative to get us talking. While we do need to find a time to talk with our family about our health histories, few things seem more doomed to failure than pushing families to talk about poor health at a gathering aimed at celebrating.

First, older adults in our families have many interesting things to tell us about that go on in their lives besides poor health. Many have good health and no reason to focus on poor health. Many want to avoid the stereotype linked to old folks talking about their health and nothing else…even when they do have poor health.

Second, younger adults who need to know about their family health history need to know details that are unlikely to be discussed in such public settings, or if they are discussed, unlikely to be remembered.

Third, it is not particularly helpful to know that there is diabetes or heart disease or cancer in your family if you don’t also know who had the condition, at what age they had the condition, what treatment they used to address the condition, and with what success. Or, knowing what family members have died from should be accompanied by information about the age at time of death.

In this  era when we have more awareness of how genes affect health and our reponses to medications and other therapies, we may want to know whether our family members have had any genetic tests. If they have, what ones led to positive results indicating the presence of a particular form of a gene? 

Talking about family health history is important but can be difficult if we don’t make time and don’t know what to talk about….

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What about public health care reform?

Sunday, January 10th, 2010

117_1784January 10, 2010

I never hear anyone talk about public health when they talk about ‘health care reform.’ This bothers me because we have a univeral system of public health in the U.S. and we spend quite a lot of resources on it. The services linked to our public health care system range from checking the quality of restaurants and ‘grading’ them to providing newborn screenings. We spend quite a lot of time deciding what services to provide in each state. Besides registering births and deaths, and newborn screenings, many states have prenatal care programs, other women’s health programs, and a wide range of programs from smoking cessation to drug prevention to cancer screenings.

We don’t talk much about public health. But what might a connected system of health care built on the system of clinics and services for public health look like? How would doctors and health care staff feel about building on their infrastructure? Some states have regional health care directors? How would they regard an effort to connect the services they oversee to a broader range of services for the public to consider as a choice for care?

Anyone?

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