Medicine

One Million Hearts Saved or 160 Million Lives Improved

Where Should Our Leaders and Our Designs Take Us as a Nation?

Million Hearts is another attempt to turn risk factors into saved lives - specifically reductions in heart attacks and strokes. The targets are once again human behavior changes (patient and provider) regarding aspirin, blood pressure, salt, cholesterol, and transfats. The campaign involves a number of federal agencies and health leaders, but the campaign will not address the top issues facing most Americans in their life, death, or health.

Health and Human Services in the United States represents biggest government that dwarfs all other world governments other than the United States government and total government in all but a few other nations. Health and Human Services and other government leaders play a key role in guiding health care in our nation as well as economics, jobs, and health spending. Not surprisingly those shaping our health care designs invest billions of dollars to influence our government, particularly with health care a much more stable investment compared to most for the last decades.

The Million Hearts Campaign has been shaped by those leading health care – government, associations, business, and insurance. Million Hearts is not a poor choice in itself. It is what Million Hearts represents that is the problem. Million Hearts represents numerous choices past, present, and future that have not worked for most Americans. These continued choices distract and divert attention from what works. A focus upon diseases and risk factors is quite different when compared to specific focus upon the basic needs of most Americans.

One Million Hearts Saved or 160 Million Lives Improved Million Hearts is another attempt to turn risk factors into saved lives - specifically reductions in heart attacks and strokes. The targets are once again human behavior changes (patient and provider) regarding aspirin, blood pressure, salt, cholesterol, and transfats. The campaign involves a number of federal agencies and health leaders, but the campaign will not address the top issues facing most Americans in their life, death, or health.
Part I Million Hearts Limitations of Awareness We demonstrate little understanding of what is preventable or not, the limits of risk factor modification (including the limits in the populations in need of modification), what it requires to accomplish greater prevention and greater proportions with prevention, what can result in fewer deaths (or what can result in more deaths).
One Million Part III Higher Priorities A Million Hearts Campaign that hopes to change human behavior should realize that the easiest and best way to change human behavior is changing humans during birth to age 8. To have people decide to improve their health, they must be invested in a better future. Children reduced to growing up in survival mode may never be able to focus on a better future.
Rearranging the Deck Chairs: Death Displacement Saving lives sounds quite heroic, but the reality is that we are at best only displacing or delaying death for a few years. We will all die. We will all die. We will all die…… We spend the most health care dollars at the end of life in ways that are wasted. We spend the most on just a few and the least on the most. We spend so much at the end of life for few that the quality of life is impaired for many.

Our Nation must stop, repeat stop, its magical thinking with far too much emphasis on innovation and reorganization and manipulations of numbers. We have far too little emphasis upon people - especially people with basic health needs and people that can address basic health needs - for entire careers with best experience and coordination and dedication. We fail to understand people and the people that serve people. When we understand most Americans and the teacher, nurse, public servant, public health, and primary care workforces that serve most Americans, we fail to understand America and what is best for Americans.

Introduction

For 100 years our national priorities have been focused upon health innovations and interventions that cost more, yield less, and benefit less.

The Million Hearts Campaign appears to be an attempt to save lives but it is still a continuation of the past 100 years and a process that no longer works for better lives or health for most Americans. Our leaders have been taught by the same people that have led the United States to the brink of financial ruin as we spend far too much on health care – impairing all budgets that involve people at all levels. This in itself makes government at all levels from school districts to the national level inefficient an ineffective as we have to cut teacher, public servant, nurse and other front line jobs just to satisfy the health care cost demands. Poor awareness has also impaired our judgment in defense expenditures, bailouts, and financial system rewards.

Those doing well in America are doing better than ever by any number of measures (top 1%, top 10%, CEOs, healthiest, wealthiest, most and best health care coverage, the most highly educated, children of professionals, highest property value living places, most social and political organization).

We have forgotten how to address the basics – basic birth to age 8 in children, basic health access, public health, clean water, sanitation, use of government dollars efficiently and effectively to make a nation more efficient and effective. We have forgotten how to maintain a nation and the people that maintain and progress a nation - those on the front line serving occupations.

In the realm of major health campaigns, we have been focused on curing diseases such as breast cancer and heart disease. Meanwhile failures in health are more evident as well as failed health designs that make matters worse for the nation. More move toward health care in search of profits as health care (especially non-primary care) is one of few routes available to profit in a sinking United States economy – an economy sinking faster mainly due to too much health care for too few at costs far too high. These campaigns have begun to abuse statistics by making claims that are just not possible – reduce smoking and obesity and save 1 trillion dollars, spend much more now to get cures from research in the future after 50 years of little gain in cures, or save one Million Hearts.

Playing the same old tunes is not going to address the needs of 160 million Americans at the current time. Shell games indicating innovation as a solution or reorganization disrespect those who are dedicated to making a difference as well as those who need a difference made in their lives. Focusing ever more attention on one area that has had 50 years of work is not likely to result in much more improvement.

The limitations of the interventions are easily seen and are the same limitations facing 160 million Americans – whose health care is more about limitations and barriers than specific biomedical markers indicating some small increased probability of future death. These predictions also use equations that are far from complete, with much or most of the reason for future death unexplained. But this does not stop the biomedically trained, the biomedically profiting, the biomedically employed, or those representing biomedical interests. Until we understand much more about the human condition and human relationships with regard to health conditions, we will not address the barriers to better life and health.

Governments across the globe have been shaken up increasingly in recent years due to government that has grown distant from the people. The United States should pay attention more than which side should win. When government has leaders that are less representative of the people and less mindful of the people, there are any number of consequences to most of the people.

Our leaders in government are less and less representative of most Americans. Our professionals that shape America's decisions are less and less representative of America. Health care is a prime example. Our health care design has been shaped by few and fails in impact for most Americans. Our health care spending and the economic impact of health care favors a few Americans in a few locations with most Americans left out by design. In such a setting it is difficult to even craft a design that can help most Americans as those that can influence designs have such a poor grasp of how to impact the daily life and health needs of most Americans. Until dominant perspectives understand that excesses for some lead to consequences for most, there will not be improvement.

So we have Million Hearts that once again attempts to turn aspirin, blood pressure, salt, cholesterol, and transfats into better lives.

We are not quite to “let them eat cake” or “fiddling while Rome burns” but we are not going to receive much gain for the effort, especially for those in the 160 million left behind. The Million Hearts campaign will directly or indirectly reinforce the past decades of more done for less at higher cost with little benefit. The Million Hearts campaign will take interventions that work best on those doing well - interventions that work less well on those who are least well – in health and job and income categories.

The Million Hearts campaign will not introduce or reinforce tough decisions that should have been made each year for 30 or more years. We must spend less on the few and more on the many. We must reduce non-primary care spending and increase basic health services spending specific to places and populations that need the basics. We must redirect spending from those nearest death or those dying to interventions that would result in improved national outcomes for future generations.

Most of all the political and health care leaders of the United States must reinforce a single basic truth – we will all die. How we choose to live or die as well as our collective decisions that shape life and death, impact quality of life for far more people than we grasp at the current time.

It takes national campaigns to focus attention elsewhere, rather than the basic needs of most Americans left behind in so many ways important to a nation – in basic nurturing and child development, in early education, in basic health care, and in other basics. Only a focus on improving the daily lives of most Americans will improve America and such a focus may actually gain far more than a Million Hearts saved because spending a little more on the many in ways that make small improvements can have major improvements in outcomes. Allowing a continuation of ever more spend for fewer for less result is intolerable in health care.

Thanks to all 12,000 who have visited Basic Health Access in 2011.

Robert C. Bowman, M.D. Basic Health Access Web Basic Health Access Blog

SMART Basic Health Access World of Rural Medical Education

Basic Health Access Blogspot 2011 - Summaries and Links for 2011

Dr. Bowman is the North American Co-Editor of Rural and Remote Health and a Professor in Family Medicine at A T Still University School of Osteopathic Medicine. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association, he was the long term chair of the STFM Group on Rural Health, he is the founding director of Priority Infrastructure at http://www.infrastructureamerica.org/ and he is the author of the World of Rural Medical Education, and Physician Workforce Studies

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