Friday, November 25, 2011

Consumers seeking information for their health

The Center for Studying Health System Change published an interesting report recently focusing on how much (or how little) people are seeking information about their health aside from asking their physician.  The report also focused on the sources of information, the degree to which different factors influenced the decision making process, and the degree to which the information sought helps individuals in maintaining their health and in deciding on courses of action.

In this age of information--books, magazines, television, the internet, friends, family, formal support groups, patient groups who share information online, etc.--it seems surprising that there would be fewer people seeking outside sources of information.  It may not be surprising that fewer people are looking to books magazines, and newspapers.  It is more surprising to me that the proportion of individuals looking to the internet had not changed very much.

The study also pointed out that individuals with lower education were less likely to seek information and older adults were less likely to see information.  What might that tell us?  Individuals with lower formal education may need the information more.  Individuals with lower formal education may be less able to use the information.  They may have less knowledge of where to find the information.  But with the availability of information is not clear why the quantity of information demanded (if we assume that individuals who are demanding information demand about the same and we are simply seeing fewer individuals accessing information) would have gone down.  Does it mean greater trust of physicians?  Does it mean that those with lower education (and possibly lower income) feel that they have fewer choices in the current economic environment and don't see the value in gaining information if they lack choice?  Does it mean that individuals with lower education (and possibly lower income) are simply worried about things other than their health care in the current economic environment?

For older adults, it is even more interesting to ask why they, as a group, are not engaging in information gathering.  Are they uncomfortable with new sources of information?  As the number of chronic conditions grows do people fell they are less able to make sense of information when there are multiple views?

No simple answers--and no simple ways of figuring out what to do about it.  Do we trust that if people wanted more information they would get it?  Do we try to provide more information?  Do we try to provide more education so that people will understand the information provided in the first place?  And what is the cost and the effect of such efforts?  Of all the ways that we might improve the health of the population, how does getting people more information rank compared with other alternatives?

Monday, November 21, 2011

Falls and injuries

Here is a link to an interesting story about loss of balance, falls, and injuries that can cost an average of $18,000:

This is not something for which I have a whole lot of answers.  It is just important to realize what can affect falls.  As the quote in the article mentions there can be disease and specific treatments for diseases that have an influence on balance and falls.

As an economist, I wonder what influences a person's decision as to whether the try to prevent specific chronic conditions that may lead to a loss of balance, how individuals make decisions about treatments for these conditions, and how individuals make decisions about whether to adhere to the treatments.  In each case, an individual faces tradeoffs that are important to understand from an economic decision making point of view.  And in each case, the individual (with the help of their clinician) may have difficulty understanding the issues faced.

I also think about population level cost-effectiveness questions.  Especially when it comes to issues like whether or not promoting or funding yoga or Tai Chi classes is cost-effective.  Some evidence suggests that it may be.  But I think we have a lot to go.

As our population continues to have more chronic conditions with more treatments for more older people, we will be asking a lot more questions like these.

Sunday, November 13, 2011


Yesterday, I ran in the Third Annual Heather Hurd 5K. At the Harford Community College, the morning was crisp and beautiful—just right for a 5K run.  I haven’t seen my official time, but I think I ran 20:29 and placed second overall.  That was a lot of fun.  I’d been second in age group twice this year, but I haven’t been second in a run in a very long time. 

This run is organized by Heather Hurd’s parents.  Heather was the victim of  a distracted driver.  Her parents have also lobbied around the country to have stricter laws passed against distracted driving.  Our law in Maryland changed on October 1, thanks to the Hurds.  Making sure not to send texts while driving is something that most people agree on.  Making sure not to read emails or texts while driving is a foreign concept to many.  As I have shared information about my run with others, I have realized that many people didn’t even know about the law.  This law seems difficult to enforce, but it is now a primary offense with a $70 fine for the first offense and a higher fine ($110) the second time. 

As I think about this law, I have had to think hard about

  1. (1) How to break myself of habits that would violate the law
  2. (2) How much I appreciate the law as a runner/walker
  3. (3) The importance of runners/walkers following similar rules

In thinking about how to break myself of the habit of reading emails while stopped (and occasionally while driving), I have now made a personal commitment to put my cell phone either in my glove compartment or even in my backpack while I drive.  Otherwise, I think that accessing it would be too tempting.  And, if I am going to run a 5K to raise awareness and hope that others will follow it, I should make sure to follow it myself.

In thinking about how I appreciate this law because as a runner, I have had several “too close for comfort” encounters with cars in the past two and one-half years of serious running.  Distracted driving can be dangerous for the drivers of the cars in which the distraction occurs, nearby pedestrians, and nearby drivers.

Finally, it is also critical for pedestrians and runners to abide by similar rules.  We have not outlawed distracted running and walking, but distracted pedestrians can be just as dangerous to themselves (and at least indirectly to others) by their actions as cars try to maneuver around them.

To extend it a bit further, also note that distractions from any task can make completing the task slower, harder, and produce less quality.  Perhaps avoiding distraction is an argument against multi-tasking in general.

Getting back to the focus on distracted driving, I realize that waiting 25 minutes (my normal commute time) to check emails again is not likely to cause anything to be late.  I sometimes feel the need to be productive in general, or to work or to be connected 24/7.  As I think about it, I can use all 24/7 of my life to be productive without having to be connected and responsive all 24/7.  Separating connection and productivity is critical moving forward.  Knowing how to balance them (and balance all the things that motivate me to even think about multi-tasking) is also key.

Monday, November 7, 2011

Interesting Study on Size and Status

Last week, the Johns Hopkins Bloomberg School of Public Health newsfeed pointed to an interesting column that was featured on the New York Times website.  The column is about how people associate the size of food portions with status.  The thought is that food is one thing that people have some control over so that when they are feeling otherwise powerless, they turn to eating bigger portions to gain some sense of power.

A couple of questions to ponder:

(1) Is this basic human nature or is it a part of American (or perhaps, more broadly, Western) culture?

(2) Is this something that can be changed?  The article suggests that it may be possible to change the perception of what holds status.

(3) Why is the size of the portion in our utility function at all?  In theory, wouldn't a rational utility function be based on satisfaction of biological needs?  Or is the fact that we have minds that can think and feel and experience emotion something that makes us so different and pushes us to include things in our utility functions other than just biological satisfaction?

(4) How expensive would it be to change the perception of what holds value at a societal level?  And, could it be cost-effective despite that expense given the large economic burden of obesity and related conditions?

(5) What is it that those who already feel in power actually seem to have very different  preferences--focusing on minimalism in a variety of ways?  Is it that power shapes preferences or preferences lead to power?  Or could it vary depending on where a person starts in life?

All of these issues could suggest something to us about how to approach trying to change the epidemic of obesity in the United States or could simply suggest how difficult the task of change is likely to be.