Saturday, March 29, 2008

Something Cool to Talk About: Mental Health

It's taken me a while to really get a take-home message. But one thing is clear -- we have got to address mental health.

In more than three sessions mental health was brought up, talked about and cried over.

Every time a presenter talked about mental health, they were so passionate about their cause that you could hear tears in their voice.

So what are the major problems? Mental health isn't being talked about, unless there is a drastic event forcing every media outlet in the country to focus on the tragedy.

But let's not focus on the tragedies anymore. Let's cover them when necessary, but not stop examining the mental health of this country. In the nursing session I attended today one of the panelists said 1 in 4 college students are affected by stress making it hard to do work. ((As a college student this doesn't surprise me, only comforts me that I'm not the only one who becomes immobilized at the amount of work)).

The college angle presents a neat news beat! Let's focus on that for a while! Let's talk about it! Let's write about it! We have the power of the pen and we can initiate change.

The end of the world as we know it?

"The take home message from these sessions is that basically we're all screwed." That's what one of our classmates said during an AHCJ session on the health effects of climate change. Pearman Parker clearly heard something quite different during the health disparities session on Friday: journalists have the power to reduce the odds of being screwed. Whether a public health problem is as old as poverty or as relatively new as drug-resistant pathogens in hospitals, knowledge is power. And journalists like us have the chance to scrutinize data, interrogate experts, and find the human stories that bring topics to life. By writing about health and medical issues, we help our readers and viewers become more savvy consumers, parents, citizens and voters.

It's not an easy job and sometimes brings us face-to-face with insomnia-inducing doses of human misery. On balance, though, the rewards of this work outweigh the costs. This 10th annual meeting of the Association of Health Care Journalists has drawn nearly 500 reporters who do this work, many of whom have been in the field for decades. Catch them in a candid mood and I’ll bet most will admit to being fueled by the conviction that it’s not too late to change the world.

Iraq War Vet: "You're not allowed to rest your mind."

The Medical System’s Looming Military-Related Demands

It has taken me a little time to process what I heard, saw and felt at the last session on Friday. Meeting Corpsman Jose Ramos (ret.), who lost his left arm in the Iraq conflict and Military Times writer Kelly Kennedy really served to open my eyes and confront head on the demands on us to care for our soldiers serving in this conflict. As the sister of an Iraq "war" vet and the niece of a retired Command Sgt. Major, it is of particular interest to me to hear from those on the front line about what they are doing for the people who put their lives in danger and their families who must cope with loss, catastrophic injuries and the stress of having a family member in the war theater.

Let me say that red tape is not a friend of mine, and neither is bureaucracy. Hearing from Gerald Cross, M.D., principal deputy undersecretary for health, Veterans Health Administration, was illuminating in its positivity. The idea that things are going so well and just improving and improving for our vets and soldiers still in-conflict just didn't jive and struck me as more of the smoke and mirrors that catapulted us into this war in the first place.

"We have no greater priority than the care of these veterans," Dr. Cross said. And because I believe him, I want to know why there are still so many problems and why the country and the military was ill-prepared to care for the wounded and walking wounded and those whose wounds don't show.

As Ramos put it: "You're not allowed to rest your mind."

Kennedy definitely brought it home for me. As an Army veteran and someone who has been with the troops first hand, she has a perspective that is unique among wartime journalists. She talked of visiting a unit that experienced an attack with a 500-pound IED that rolled over a Bradley vehicle. They watched as a member of their unit was trapped under the Bradley and burned alive; they watched as a female MP was decapitated by an RPG, Kennedy said.

"I know we’re five years in and we weren’t prepared for this war," Kennedy said. "Shouldn’t we have a handle on it. I guess I’ll just leave it at that."

So will I.

Care After Cancer

Day two rolled around and I rolled out of bed still stuck in yesterday. But thankfully I made it to the conference on time to attend my first session titled “Cancer Survivorship.”

OK, so this wasn’t an attractive feature. But, like I posted earlier, my grandmother was diagnosed with breast cancer and my eyes perked up when I saw the topic outside the room.

I must say this was one of the first sessions I paid close attention to, but I can’t exactly figure out why. It was just fascinating to me.

I’ll get to the point of the blog now, I guess.

We heard four panelists talking about cancer – choices, support, physical activity and life after cancer. That being said, life after breast cancer should not be ignored in the press.

Perhaps we should write about stories regarding how physical activity helps recovery. Perhaps we should write about the theory of empowerment and what it does for making choices. Perhaps we should write about women’s stories – give me a long feature please.

I loved it all. I wanted to write it all. If I heard this talk two months ago, I really would have had a long feature to write.

Friday, March 28, 2008

How Will Retiring Boomers Affect the National Health Agenda?

Who Will Care for Us?

Didn't really get an answer to this question. What I heard was the panelists saying that that retiring boomers will affect the national health agenda and that the agenda must change to include that rapidly growing population.
Daniel Perry, Executive Director of Alliance for Aging Research, says as we look ahead, we're going to experience many consequences as a rapidly aging society, particularly as it concerns the health of the baby boom generation.

Some statistics:
  • In the last 100 years, we have added more years to the average life expectancy than in the previous 5,000 years.
  • 37 million Americans are 65 or older
  • Care for those with chronic conditions consumes nearly 75 percent of health care spending.
  • Almost half of all Americans have a chronic condition
  • By 2030..national health care expenditures will reach $16 trillion
  • 76.8 million eligible for Medicare
  • 171 million Americans will have chronic health problems.

The health workforce is also largely unprepared to deal with this rapidly aging population, Perry said, with just five of 144 medical schools housing a full department of geriatrics, which is an increase from one school a few years ago.

"We’re starting in the most feeble way possible to make geriatric medical care a priority," Perry said.

He points to a "bias" to treating old people among those entering the health care field and training medical doctors.

"Most medical schools are very political places where the monies that are there to be distributed tend to go to high tech fields of medicine," Perry said. "So much of geriatrics is low-tech high-touch.... We need to have far more training, more required courses, rotations in nursing homes."

Joshua M. Wiener, Ph.D., senior fellow and program director for Aging, Disability and Long-Term Care at RTI International, said to be on the lookout for a major report on the health workforce for an aging society, which will be announced and released April 14.

Violence and Mental Illness

I wasn't going to post anything on this topic, because it hits pretty close to home for me. I have an uncle who was diagnosed with mental illness in his early 20s. He is now in his mid 50s. A few months ago he asked his doctor why he had been on the medication for so many years if he wasn't getting better. When is he going to be able to go off his medication? It is a heartbreaking question to hear and the answer was even more difficult: Never. If he wants to function at any level, the medication (which has changed recently) will always be a part of his life.

There is a struggle, too, within my family in how to deal with my uncle. Some don't think he's sick; some think he's too sick. The daily struggle to help him deal with his illness has been something that my mother (his youngest sister) has taken up.

I say all that to say that I can relate strongly to the tension that Dr. Jeffrey Swanson, Ph.D., eloquently discussed in his responsive remarks:

"There’s a tension in mental health and the law and what we should do in terms of policy," said Swanson, professor in psychiatry and behavioral sciences at Duke University School of Medicine. "One way to characterize it is in terms of the concerns about autonomy and paternalism. Grappling with that tension is a very important thing to do in understanding how we view a problem such as violence and mental illness."

The solution that nearly everyone mentioned in regards to the perceived and real link between is to make sure that individuals who are mentally ill receive treatment. We must also recognize that not everyone who is diagnosed with mental illness or who is mentally ill does not believe that they have a problem.

Luncheon Roundtable: Which Way Health Reform?

The Luncheon Roundtable was energetic and lively.

In a nod to my professors at UGA who dine every day (just about) at the Faculty Dining Room on campus, I will offer a brief review of the meal. It was finely balanced with a starter of side salad with raspberry vinaigrette dressing, main course of grilled chicken, mashed “potatoes” and broccoli. Dessert was a bit of a mushy mix of raspberry/wafer cake concoction that I didn’t appreciate in its entirety.

The discussion was a pretty exciting and somewhat contentious (largely good-natured….mostly) discussion about the possibilities for health care reform in the United States. David Himmelstein, M.D., associate professor of medicine, Harvard Medical School, and Tom Miller, resident fellow, American Enterprise Institute, went back and forth on the barriers to health care reform and who was sort of causing the problems or standing in the way of the solutions. Karen Davis, president, The Commonwealth Fund, said that we pay more and get less care than we should. Julie Barnes, deputy director, health policy program, the New America Foundation, sounded the loudest drumbeat, and implored journalists to be positive about the possibility of health care reform and include “solutions” and not just “problems.” The mission, she says, is to “preach hope” and “dispel fears” about health care reform.
I'm not sure how much she knows about how journalism is practiced in the U.S. if she believes we'll report on the solutions. We tend to thrive on conflict for the sake of competition.

Julie Appleby from USA Today was a snappy moderator who kept things moving along.

The problem, though, is that it seems that no one can agree on these solutions or how to reach a consensus on them.

One way to get there, at least two panelists said, is to change how we pay doctors; move to a model based on quality, not quantity. Not sure how the doctors and hospitals will feel about such a change.

I had to duck out early because my contacts were bothering me…

Breast Cancer: The Other Story

After shuffling around the hotel to find Salon B, I finally found the room to learn about something close to my heart — breast cancer.

Vanessa Sheppard, assistant professor, Lombardi Comprehensive Cancer Center, spoke about this disease and all the sociological issues surrounding breast cancer.

Breast caner is the leading cancer in women and second cause of cancer death. Despite this commonality, racial and ethnic differences in quality of life exist related to socioeconomic status.

Sheppard focused mostly on African American women — the highest mortality of all ethnic groups. Among these women, there is a lower incidence among younger women and less likely to have adjuvant therapies.

So she created a program called Sisters Informing Sisters, a program designed to educate, inform and support.

The fascinating component about this program is that they offered a survivor coach to help women cope. This was a wonderful idea to me. It broke down the fears and worries of women that may have difficulty communicating with their health care provider. Got a question? Don't know how to ask? Just talk to your trained survivor coach!!

And so why is this so close to my heart? My grandmother was diagnosed when she was 65. I cannot imagine the support that she could have had if she was lucky enough for a survivor coach. Maybe some things would have been clearer. Maybe she would have had it easier. At the very least, she would have been more educated. But thankfully, she survived and I only wish that she could be a survivor coach for other women.

Community...The Health Story

"Unnatural Causes: Is Inequality Making Us Sick?" premiered on PBS last night, the first of four parts. It looks at the social determinants of health and explores how who we are can determine how long and how well we live is determined by forces beyond biology.
It also discusses the role of public policy in reducing inequality.

The session is off to a great start with a short preview of the first episode, which Patricia Thomas, the Knight Chair in Health and Medical Journalism at the University of Georgia's Grady College of Journalism and Mass Communication, screened last week in Athens, Ga.

A.H. Strelnick, Director, Institute for Community and Collaborative Health and Monetfiore Medical Center is talking about last Sunday's NYT article "Gap in Life Expectancy Widens for the Nation."
Strelnick says we've not been able to solve our cost problem for health care or improve the health that our socioeconomic status should give us.
We have to look to "deeper problems," and that means "looking under the surface for the true roots of our health problem."

Strelnick referenced “The Solid Facts” which looks at different sources of social determinants of health, including: The Social Gradient (deprivation, poverty, disadvantage, class, education, etc.), Stress—the embodiment of how you take your experience turns into biology, and social inclusion (discrimination, isolation).

The question from Strelnick that he asks of his residents: What’s been the most successful anti-poverty program ever created? The answer: Social Security, which allowed the poorest person category in America from an elderly widow to a child of color.

"We’ve reduced poverty for some groups, but not for others," Strelnick says.

Llewellyn Smith, co-executive producer of the documentary, and president, Vital Pictures, Inc., says the research itself is not new, but there has been a resurgence in interest in health disparities and the inequalities surrounding health and public policy.

"This is really the first time this is communicated and translated into stories that people can actually access," Smith says. "If you begin to map neighborhoods, you can see that there are some communities where people are going to live 10 years longer than others.
Those communities, Smith says, are the same places that have the good schools, green spaces, access to good foods.

"You can se e a clear visual pattern. Is that a natural pattern? Is that a fact of nature?" Smith says. "If it isn’t, that means we can do something about this."