Wellness

Meaningful Innovation

Why we should be focused on food now.

Did you catch Eric Schmidt on Face the Nation this weekend? He’s helping leaders reimagine parts of the economy. Interestingly, he touched on many of the topics covered in the Weekly Rush over the last several months including housing and infrastructure to facilitate remote work and education. 

Last week, I raised the need for meaningful innovation in healthcare and incentives to influence industries that effect the health and wellbeing of all Americans.

I’ve been thinking with the food supply chain since visiting family in rural Canada last year. The problems were really clear to me then because my point of reference is California.

When you live with abundance, it’s eye opening when you can’t get what you need. Hopefully, the stories about crops being destroyed, animals being euthanized and shelves sitting empty are illuminating the problems for others now too.

I recently discovered the 2030 Agenda for Sustainable Development and more specifically, how it relates to food.

Stats

“Approximately $1 trillion of food is either lost or wasted annually – an amount that accounts for nearly one-third of the world’s food. According to the UN Food and Agriculture Organization (FAO), ending food waste would preserve enough food to feed two billion people. That’s more than twice the number of undernourished people in the world.”

Food is a problem in developed countries. At the end of 2019, over 39 million Americans received food stamps from the Supplemental Nutritional Assistance program [SNAP]. With unemployment above 14% now and climbing, it’s safe to assume more Americans are eligible for the SNAP benefit and likely in need of other food subsidies.

Despite the Trump Administration’s optimism about an economic rebound in the summer, history tells us main street and all the people who work on main street are not going to recover that quickly. The need for food subsidies will likely persist for the next decade.

Opportunity

Addressing food waste is reportedly one of the most important things we can do to also reverse global warming. Why? Think beyond the wasted food to all the resources and energy consumed to grow, harvest, produce and transport the food.

Without getting into specific ideas now, Covid19 poses the opportunity for us to change:

1/ What we grow

2/ Where we grow it

3/ How we grow it

4/ How we harvest it

5/ How we distribute it

Stakeholder Capitalism

A recent WSJ email answered the question about whether or not we’ll see a shift to Stakeholder Capitalism following the Covid19 shut down. Only 18% of leaders are expecting to make the shift.

The response is disheartening when as an industry we’ve heard nothing but complaints from them about the rising cost of healthcare. If you consider the Sustainable Development Goals, leaders outside the industry have just as much or more control over their rising healthcare costs as the healthcare industry.

We should have a shared responsibility in addressing the goals, reducing the cost of healthcare and achieving peace.

2030 Agenda for Sustainable Development

“The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. At its heart are the 17 Sustainable Development Goals (SDGs), which are an urgent call for action by all countries – developed and developing – in a global partnership.”

17 Sustainable Development Goals

1/ No poverty

2/ Zero hunger

3/ Good health and well-being

4/ Quality education

5/ Gender Equality

6/ Clean and sustainable water

7/ Affordable and clean energy

8/ Decent work and economic growth

9/ Industry innovation and infrastructure

10/ Reduced Inequalities

11/ Sustainable cities and communities

12/ Responsible consumption and production

13/ Climate action

14/ Life below water

15/ Life on land

16/ Peace, justice and institutions

17/ Partnership for the goals

Co-Housing

Could co-housing help solve the homeless issues?

Did you catch the Fortune article asking “Can San Francisco be saved?” The article raises the point that for people without housing, there is no health. Unfortunately, the story gets worse.

Many medieval diseases [typhus, tuberculosis and likely Covid19 soon] are now showing up in the homeless populations and consequently, threatening the health of everyone else too. 

We have to deal with this problem because things are only going to get worse for everyone if we don’t.

Co-housing

I’ve been indulging my interest in design lately and attending lectures on architecture and home design. 

People are always curious about why I’m there. The answer is simply curiosity and interest. However, in conversation I mentioned was that I was interested in the intersection of housing and health as well as design and health.

As soon as you state a clear reason, people start sharing ideas and offering resources for potential solutions. Co-housing is one of the solutions that a really successful architect mentioned to me.

Co-housing incorporates all of the elements of a multi-generational community under one big roof. It includes both private and common spaces. Similar to corporate culture, shared values makes the co-housing community work.

It works for some and possibly in some cases, like addressing the homeless population. 

[Re]Orientation

I spoke with a consultant who works with organizations on issues related to bias. She also volunteers with non-profit organizations that assist underprivileged women.

A short conversation with her is all you need to understand the flaws in our current approaches to addressing the homeless issue. Housing is important but it’s the first step in a relatively long process of helping people to re-enter society.

The homeless population needs to be reoriented to living in a home so that they learn the proper use and care for appliances and learn the social norms of living in a residence.

Once the initial orientation period is complete, the hard work of addressing their underlying problems begins. Depending on the individual issues, people may or may not have the bandwidth to hold down a job.

We often think of dollars spent rather than dollars saved. However, professionals working with the homeless industry benchmark savings against inpatient hospital costs. The cost per day of properly serving the homeless is about five times [5X] less than a hospital day.

Plus think about the duration of the expense. No long term solution, no limit on the cost.

Community

What many of us don’t appreciate is that the homeless have a community and people who watch out for them.

When they are placed in housing outside of their community, it creates additional problems and doing so may never help solve their original issues. 

We need to think about how to preserve those communities during their transition back into society. That’s why co-housing might be a good option.

The question that remains is given the limited supply of land and affordable housing in most major cities, how do we create these structures without building on golf courses, parks and other plots valued by others in the community.

Ideation

Have you seen that HGTV design show about people living in repurposed firehouses, lighthouses and ships? 

That’s why I can’t help but think repurposing old cruise ships as transitional co-housing homes might be an answer. Many of the homeless are in cities along the coasts with real land constraints. 

Cruise ships have private rooms, commercial kitchens, large dining areas, outdoor space, medical facilities, gym and recreational areas. Plus it would be an easier way to scale up and if all goes well, scale down as demand falls. They seem to fit the bill.

With that said, there are a lot of experts who have ideas and insights to address the issues. We need to engage with them to generate ideas and develop a now-near and far strategy to address the homeless and shortage of affordable housing.

Employers need to be part of the long term solution because most people migrate to cities for work. With the quality and affordability of technology, there’s really no reason for people to move. We just need to open our minds to new possibilities.

Conscious Capital

Can entrepreneurs and conscious capitalists solve all the world’s problems?

I’ve been researching impact investing and some of the ideas around it including stakeholder capitalism, conscious capital and frugal innovation.

While I don’t have my arms fully around the topic yet, I see somewhat of a ground swell happening that is important to acknowledge. More and more people of all ages are looking for broader meaning in their work.

I’ll share a few ideas and discoveries now and will circle back with more.

Surgery

It seems like everyone wants to point their finger to one reason or another for why healthcare costs have skyrocketed. However, the one reason that doesn’t get much attention is the “number of sophisticated options” that are available now. It’s likely because progress is viewed as something positive.

The problem is that many people don’t have access to the sophisticated options because they’re too expensive. Did you know that over 5 Billion people don’t have access to safe surgical services? It’s a bigger problem than HIV/AIDS, TB and Malaria combined. 

Equipment costs are part of the problem. I recently discovered an emerging medical device company that is making the needed equipment more affordable through frugal innovation. 

They have been working in some of the most resource constrained countries and challenging situations with high demand and now are making inroads into the US healthcare market. It will be interesting to learn how their value proposition translates and how physicians respond to the idea of frugal innovation. 

Frugal innovation is more than a strategy. It denotes a new frame of mind: one that sees resource constraints not as a liability but as an opportunity — and one that favors agility over efficiency. Frugal organizations don’t seek to wow customers with technically sophisticated products, but instead strive to create good-quality solutions that deliver the greatest value to customers at the lowest cost.

Prevention

According to Be the Solution, 75% of the $1.4 Trillion annual US healthcare spend is on chronic diseases that are preventable with better lifestyle choices. 

It seems like a big number. However, it’s inline with my 2018 estimate of $874 Billion which includes the spend for spine and joint issues [35%], heart disease [35%], diabetes [12%] and obesity [18%].

Changing bad habits is not easy. Habit formation experts believe that changing a habit that requires one decision [i.e. flossing or exercising daily] is easier than changing a habit [i.e. diet] that requires moment-to-moment mindfulness, virtuous behavior or an entire set of new habits. Even then, bad habits can be easily rekindled if you’re not mindful. 

What’s not clear to me yet is whether or not there is a viable business model to support habit change or if sales tax is the better solution for curbing unhealthy behavior.

Optimism

Be the Solution is somewhat refreshing. The book acknowledges the magnitude of the problems ahead but reframes them as opportunities for entrepreneurs and conscious capitalists.

You can’t take on the world’s challenges if you’re not in the right state of mind. So I’ll leave you with a reframe exercise to do.

According to positive psychologist Martin Seligman doing these seven [7] things will improve your health, happiness and well-being:

1/ Cultivate positive emotions about the past by increasing gratitude, forgiveness and letting go.

2/ Cultivate positive emotions about the future by learning to recognize and dispute pessimistic thoughts.

3/ Cultivate positive emotions about the present.

4/ Cultivate a state of flow.

5/ Develop virtues that lead toward a sense of gratification.

6/ Develop your signature strengths in work, love and parenting.

7/ Use your signature strength in service of something bigger than you.

Healthcare is Hard

It shouldn’t be so difficult….

I’m hearing this statement a lot this week and my guess is that you might be thinking the same thing too.

Let me start by giving you some context from my week.

Leadership

I was invited to interview for a spot an in upcoming national leadership summit and in preparation, was given sample interview questions. One of the questions: “how have you overcome challenges such as discrimination?” 

The reality is that I haven’t overcome discrimination [age and gender] in Corporate America but rather learned to survive it. The stats help tell the story. However, I was concerned about my answer because overcoming and surviving are two very different experiences. 

When I consulted my coach about it, her response was “it shouldn’t be so hard”. Being a subject of discrimination is hard, taking about it is hard and for some, listening to others talk about discrimination is hard. For many, it raises feelings of fear, blame and shame.

Some leaders are reportedly calling out the behavior. I’m not sure exactly what that entails but I do know that clarifying intentions during planning helps people think about their objectives and potential biases.

I’ve also started sharing some of my stories with colleagues. It’s helped to lower their defenses and made the issues easier to discuss. Sharing our challenges gives others perspective and helps leaders take the right corrective actions.

We can’t change what we don’t understand.

Physician Referrals

In the spring, I participated in a film for a public health event. The physician creating the film asked me about the role physicians should play in promoting health to their patients. He wanted to know whether they needed to be health and fitness gurus or what?

Physicians are highly trained professionals. Healthcare executives want physicians to be working at the top of their knowledge and skillset [aka: medical license] so that everyone gets the most from their expertise. Diet and exercise are foundational to health but they’re at the bottom in terms of knowledge and skill.

The problem is that in shifting to Value Based Care, physicians need to have a way to mitigate medical risk rather than only treat patients when they’re sick. Hence, the question.

What is the best way to engage physicians in maintaining the health of their patients?

We already have a universal measurement for healthy weight – Body Mass Index [BMI]. It’s something that is routinely calculated and/or captured in Electronic Health Records [EHRs]. A BMI outside the normal range is a clinical indication that something in the patient’s diet is off.

So what are physicians doing with the BMI result? I’ve never asked the question. So I’m wondering if physicians are offering patients a referral to a Dietitian and if not, why not? Dietitians are the experts in nutrition.

To solve some of the chronic health issues, we need to think about why it’s so difficult now and what needs to change to make the process easier for physicians, clinicians and patients. More specifically:

  1. Who is currently doing the work vs. who should be doing the work [considering knowledge and skills]?
  2. Is there a problem with the referral process and if so, how can we make it easier and/or better?
  3. When should digital health solutions be introduced into the discussion with patients?
  4. Who should be choosing the digital health solutions recommended to patients?
  5. Do physicians/clinicians need to monitor the patient’s progress or is the standard data collected at time of service enough? Think about what’s novel vs. necessary.

US Veterans Service

David Shulkin MD, Former Secretary of the US Veterans Affairs, wrote a new book called It Shouldn’t be this Hard to Serve your Country.

In a recent interview, he mentioned that there are back channels working in the Trump Administration to privatize the VA health system. Reportedly, his work didn’t support that effort which is why he is out.

Verily just announced their VA project to help lower the cost and improve the outcomes for total joints.

Hiring for Fit

Have you ever wondered why 80% of Americans are in jobs that they don’t enjoy?

The easiest answer is that they have the skill and need the money to support their family, pay off their school debt, buy their dream home or maybe it’s just about survival.

Whatever the case may be, the way companies hire may be compounding the problem. Why? Companies often recruit based on past job title, education, school etc. They don’t understand why people did those jobs, why they chose their school or their major.

Chances are people made those decisions early in life when they didn’t really know what they wanted to be, how they wanted to apply their skill or where they wanted to live. Their decisions were likely influenced by their parents or a teacher or life circumstance.

If they’re trained in something that they don’t enjoy and they’re continuously recruited for that skillset, they’re probably not going to be happy doing the job. They’ll do it but they’ll also keep their options open.

Understanding WHY they made certain decisions and WHY they are interested in a certain company and job, might be better ways of understanding fit.

Unless deep functional knowledge is needed to do the job well, skills and knowledge can be developed – motivation and satisfaction can’t.

Food + Health

Have you read or watched the documentary called Food Inc.? It is eye opening.

The US government reportedly subsidizes farmers to produce large amounts of corn below cost. Corn and corn bi-product is found in everything we eat – from meat to sweets.

The problem is that it’s having an effect on your health and wellbeing for a number of reasons:

1/ Your weight: Corn is being fed to chicken, pigs and cows to make them grow faster. The additional weight impairs their organs, their ability to move and in some cases, life expectancy.

2/ Your health: The way growers [aka: farmers] work, they are contaminating the environment with hazardous waste that ends up in the food supply during processing. Unfortunately, the way meat is massed processed, there is no way to trace the contamination back to the source in a timely manner. Hence, wide spread outbreaks of e coli and untimely recalls.

3/ Your job: There was a time when a meat processing job was a good paying American job – not anymore. It’s one of the most dangerous jobs and often performed now by undocumented workers. Some of the undocumented workers lost their corn farms due to US policy.

The Food lobby is strong which is why you don’t hear much about these issues in the news. Overcoming the impact is definitely a challenge for the healthcare industry.

Medicare for All?

Medicare for All vs. Single Payer System

62% of Americans support the idea of “Medicare for All” even though it’s not clear what it would cover, who it would cover or how it would be administered.

So what are people finding so appealing about it? The number of people supporting a single payer system is lower. Reportedly, only 48% of Americans want a single payer system even though the two are similar in concept.

Is that people understand Medicare coverage because they have had some experience with it or in their minds is there a fundamental difference?

Single payer systems are often plagued with access issues because all the resources are being consumed by older and sicker beneficiaries. However, if something is urgent and life threatening, it gets taken care of quickly. In short, it’s reactive care. That’s probably the scary part of a single payer system for most.

However, what few realize is that many of the single payer systems around the world have a commercial layer that provides access to complimentary care providers who help keep people healthy. Interestingly, the plans are often provided by employers and include luxury benefits like massage therapy.

Single payer vs. Medicare for All: What’s the difference to you?

Health + Healthcare

Is health a personal choice or is there a role for physicians?

A friend recently said to me that the best thing a General Practitioner [GP] could do is write a referral to a specialist. He’s not in healthcare so I had to ask whether he thought GPs should help keep people healthy. He said no. Health is a personal choice.

Are GPs limited in what they can/should do for us by our limited expectations of them? Has the healthcare system trained people to have limited expectations? Or are GPs truly limited in their scope of work?

This conversation relates to another recent conversation with a dialysis nurse as well as our post on complimentary care providers. The dialysis nurse uses a GP that works as a complimentary care provider similar to a naturopathic doctor that helps assess among other things hormones and vitamin deficiencies that affect sleep, weight, mood etc.

The work of a complimentary care providers extend our ability to live healthy lives but few people know about them or know what they can do. Why?

The problem is that complimentary care providers are typically not integrated into the healthcare system and coverage is limited.

Apparently when they are integrated, GPs get the benefit of seeing what’s done and why. They get the full scope of the patient’s care. Patients get comprehensive care that helps them live healthier.

Post: Workplace Wellness

Fundamentals of wellness in the workplace.

Wellness is for companies of all sizes. It doesn’t take a lot of money to provide employees with a workplace that promotes wellbeing and empowers them to do their best work.

1/ Environment: The workplace itself matters. Fresh paint that enhances the light and a well organized space will promote a feeling of calm.

2/ Tools: Get creative. White boards and colorful markers are great tools to engage people in problem solving.

3/ Location: Reduce travel time. Incorporate collaboration tools to enable remote work and work from home programs.

4/ Travel: Reimburse and reward healthy choices. Allow for expenses the promote walking, healthy meal choices and exercise.

5/ Education: Provide a path for growth. Online education is an affordable way for companies to promote continuous learning.

6/ Coaching: Provide diversity and equality training. Appropriate behavior and conduct for the workplace needs to be defined so that people are clear about what movements like metoo means to them.

7/ Compensation: Provide equal pay for equal work. Compensation is the foundation of health.

Everyone wins with the fundamentals.

Post: Despair

Should wellness programs include an unrestricted education benefit to stem the tide of despair?

Have you heard the term Diseases of Despair? I hadn’t until today but couldn’t help but think at least some of the drug abuse problem was a function of the fact that life just sucks for some Americans.

How do we make it better?

1/ If you think about Maslow’s hierarchy of needs, the foundation includes the basic things people need to sustain life [housing, food and water etc.] and feel safe.

2/ If you think about how to move people up the hierarchy, they need education, job training and coaching to develop the life skills needed to be independent and successful.

The problem is two fold. 

1/ Many Americans have been without a foundation for a long time. They need healthcare and in many cases, lots of healthcare to restore their health.

2/ The other problem is that the foundation is still eroding for many Americans. If foundations continue to fail, more will suffer Diseases of Despair. It’s likely stressful for employees at the breaking point.

Americans need to address the problem with social programs and stem the tide by investing in people.

Extending wellness programs to include an unrestricted benefit for online education might help stem the tide. It’s an affordable offering for employers to consider.