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December 22, 2011

A Whole New World

Dear Friends,

It's been a month of soul searching, with a lot of soul-finding.

I've discovered that my passion for preventing chronic disease is matched by my new-found passion for health policy. My health policy class was one of the most amazing experiences I've ever had. I met people from all over health care: pharmacists, nurses, physicians, a quality and safety officer, and people with years of experience in health care administration. They opened my eyes to possibilities that I had never dreamed of, and to ways that my ideal of stopping chronic disease before it starts can be implemented. I feel terrified for our current health care system, but hopeful for the future.

My Masters in Public Health program at Jefferson has been the most important educational experience of my life. I have been transformed. No longer do I see things purely through the lens of class warfare, though I will always be on the side of the workers, when there is a dispute. I see the crisis in our health care system as one where all the parties must join together to fight disease. The enemy is disease and disability. We do a good job at treating disease, but are much less adept at prevention. If I could go back in time forty years and find out what exactly caused my step-mother's breast cancer and fix it, or my mother's stroke, I would. But I can't. As an epidemiologist, I can't help but look at people as cases and controls. Why do some get sick and others don't? I look at my niece Madeline, who is seven, and has breast cancer on both sides of her family, both her mother and her aunt. The urgency to find a way to prevent disease reaches a fever pitch when I think of her. "Never Madeline!" is my current battle cry.

And not just my well-insured, well-nourished Madeline whose wonderful parents are raising her with every advantage to help her be healthy later in life. They model healthy eating and exercise and they involve the children in activities that build their strength and balance. Their current favorite is kid-karate, which they call Ninja School. What about all the other Madelines, who don't have so many advantages? Who is going to call their parents to remind them to get their kids in for vaccines when they don't show up because they don't have transportation? Who is going to figure out how to end the childhood obesity problem that will bankrupt our nation's healthcare system as these kids grow up?

The key to prevention is a long term strategy that looks at patients as long term investments, not as risks to be unloaded when they become ill. We learned in my health policy class how Patient Centered Medical Homes, Accountable Care Organizations and Integrated Delivery Systems can do this. I've learned from epidemiology just how important prevention is. Heart disease, stroke, diabetes, and even cancer are largely preventable: if we begin prevention early enough. Yet our current system focuses too much on sickness rather than wellness, rewarding over-testing and over-treating while starving simpler, cheaper preventive measures. The incentives in our health care system are broken and I want to fix them.

My health policy professor, Dr. Lynne Matthews, has been a fairy godmother to me. She encouraged this union organizer to think big, apply my knowledge and skills to the problems of health policy, but also open my mind to new perspectives. Her unfailing support has been a large part of what got me through a sad time, and I look forward to being colleagues forever.

I am moving in new directions, and have decided that keeping up this blog no longer makes sense. I continue to practice moderate CR with lots of yoga and exercise for my own health, and I encourage those who are interested to do so, but I do not wish to be a spokeperson for CR. As a public health advocate, I do not want my personal practice of CR to be confused with any public health recommendation I might make.

I'm so grateful to all of you, for your love and support and comments and questions. For sharing your journeys with me. This has been an incredible 7 year experiment.

I'm giving you some notice so you can download your favorite back entries. But soon, I'll be taking the blog down.

You've given me the courage to follow my dreams. Now I'm going off to follow them, wherever they may lead.

I'll let Bruce Hornsby, in a song he wrote but Huey Lewis made popular, "Jacob's Ladder," have the last word for now. It's how I feel for our health care system, and what I wish for all of us.

"All I want from tomorrow is to get it better than today!"

Posted by april at 8:09 AM | Comments (16) | TrackBack