In a few minutes we will sit down to listen to Dr. Richard Carmona, the 17th Surgeon General of the United Status and a leading health advocate. His speech will cover what he believes are key issues that our HES teams will face today.
It’s interesting to note that a number of the HES participants are close friends with Dr. Carmona. The caliber of our participants is very high.
Dr. Carmona entered the room following an introduction from the Humana Arizona Market President. Dr. Carmona had a humble beginning and rose to prominence on a very non-traditional path. He was a high school drop-out turned decorated special forces officer in Vietnam who returned to get his GED and graduate from the top of his class at UC San Francisco medical school. He has spent time as a police officer, has created and managed statewide EMS systems, and has practiced vascular surgery and emergency medicine. In 2002 he was confirmed unanimously as Surgeon General. During his term he focused on preventative medicine and wellness among other duties. Not long after becoming surgeon general, his former high school awarded him an honorary high school diploma.
Dr. Carmona Takes the Stage
Dr. Carmona quickly launched into a description of how the major health issues facing America could be solved and result in drastic change. The lowest hanging fruit was smoking. In 1964 the surgeon general created the first surgeon general’s report on smoking. He enumerated deleterious affects of smoking on individual health and on the cost of care. In 40 years things have gotten better, but the solution isn’t there. We still haven’t been able to bring costs down. The government still subsidizes tobacco farmers. Carmona’s point was that we have to change the way we do business.
Carmona then turned to the number two (closing on number one) killer in America: Obesity. As you gain weight you gain risk for all kinds of disease. Once again the method of solving the obesity epidemic is to change the way we do business. A lot of nutrition issues stem from Farm Bills that were created decades ago. We subsidized farmers to grow things that make people fat. Historically these bills were created to protect small farms, but there aren’t many small farms any longer. Most of the food we eat doesn’t come from our local communities. Carmona advocated subsidizing local farmers markets instead.
These are variables that aren’t in our simulation. They are national issues, and may not fit in with the small community scope of HES, but they are things one must consider when trying to cut healthcare costs.
Some representatives in congress once asked Carmona, “If we make America healthier, wouldn’t it cost the country more since they’re living longer?” His answer was yes, but who wouldn’t be willing to pay for more quality years? No one wants to spend 20 years on a ventilator. The longer people are working, living good lives, the more taxes they’re paying for that level of care over the years; and its better for everyone.
After 9/11 Carmona stood in front of the White House and equated obesity with terrorism. He claimed we are in a war against the death of 9 million children, saddled with chronic disease in the years to come. Carmona called it a national security issue. When the White House called him, asking what he was doing, he explained: Our military is lacking in troops because many people can’t pass their physical health requirements today. In a few years, those 9 million overweight or obese children are going to be unable to join the military and therefore will be unable to defend our country. In time, our country won’t be fit enough to support the military any longer. The military knows this and just a few months ago started a pre-boot camp in South Carolina designed to get people in shape just so they could qualify for traditional boot camp. To Carmona, this indicated a major national security issue.
In the 1900s, Native Americans lived till 70 or 80 years old, while all other Americans died at the age of 50, typically from infectious disease. This was because the Native Americans ate organic, locally grown food, exercised everyday, and lived without the stress of western life. Today Native Americans die 20 years earlier than everyone else in America. They have higher rates of obesity, diabetes, and depression than almost any other demographic. The suicide rate among Native American youth is astounding. The Native Americans are cloistered, stuck on the reservation, and forced to eat the food that they’re given. Carmona told us about a tribe he visited that historically fished in a river that was once rich with salmon. When the tribe was moved to a reservation, their obesity and depression rates skyrocketed. According to the researchers studying the reservation—the children had zero Omega-3 in their diet because fish was no longer part of their daily intake. The researchers started to supplement the diets and in time saw a rapid decline in obesity and depression.
So how do we take the complicated medical information that we have gathered from researchers and clinicians and translate it to inform the general public? How do we change behavior?
Camona tells us we have to tell people what matters to them. Dr. Carmona grew up in Harlem in a largely Hispanic community. The grandmothers, or abuelitas in that area would generally cook very fatty food, rich with lard and meat and low in fresh fruits and vegetables. Carmona realized that he couldn’t tell those grandmothers that they needed to change the way they cooked. You didn’t mess with the abuelita’s kitchen. In order to change behavior, you had to tell them what they were feeding their grandkids was destroying their futures. The fear of the suffering their progeny might face due to their eating habits was far more motivational than being told their cooking was unhealthy.
Dr. Carmona Answers Questions
Dr. Carmona was very adamant about involving the people in their health care needs. He made it clear that without behavioral change, nothing would ever be fixed. But a lot of the responsibility of bringing about that level of participation rests on the shoulders of decision makers. Health literacy is very important to getting people to demand the “burning platform” of health care improvement. We have to convince people that living longer, younger is better than anything else; but they have to be a participant in this cultural change.
Carmona had great things to say about the Health Economy Simulator:
“Americans want and expect the best healthcare, but they want it yesterday and they don’t want to pay for it. In simulators like (HES) we see that everyone has to give a little…. I’ve seen nothing else like it…I love this program.”
He also stressed the importance of health in relation to issues like security, “No matter what sector of society you look at, if you don’t have health, you don’t have anything.”
In the end, our conversation with Dr. Richard Carmona returned to the same topic: the need for behavioral change from the top down and the bottom up. Without the participation of the citizenry many of our efforts to improve the health of Americans will fail. This sentiment seemed to be shared by the entire audience, who gave Carmona a resounding applause.
Dr. Carmona is now the Vice Chairman of Canyon Ranch, CEO of Canyon Ranch Health Division, and President of Canyon Ranch Institute. He is also a distinguished professor of public health at the Mel and Enid Zuckerman College of Public Health at the University of Arizona. He lives in Tucson, AZ.
All statistics and opinions in this post are a summary of Dr. Richard Carmona’s address to the Arizona Health Economy Simulator and do not reflect the opinions of Humana Inc., or its subsidiaries.
Carmona gets it. Why aren’t we talking about the right things in DC? YES, it’s critical to cover the uninsured. But if we don’t do something about the costs in the system and the health of our country, we’re going to clog all our financial arteries as well!