Category Archives: Healthcare Information and Trends

You’ve Improved!

Eating VegetablesThere was a time in my childhood when I had gained a bit of weight. Yesterday, browsing through the faded photographs, I tried to imagine how today’s American pediatricians might respond upon seeing my own heavier image as a child. Most would almost certainly find me overweight, perhaps counsel my parents about exercise and healthier eating. The way it was, my pediatrician back then – in mid-1970s Former Yugoslavia – playfully pinched my cheek and exclaimed, “You’ve improved!” She was not joking. She really meant I looked better, healthier.

I reveal this personal story to point out how our values about body image, including obesity, are socially defined. Throughout much of human history, and certainly still in many cultures and countries of the world today, being “over”weight is actually preferred to being skinny. Many people don’t view extra weight as a health concern – just the opposite! For example, in a place where hunger has been omnipresent in the recent past, a larger body may still be viewed as a sign of good health, good fortune, strength and attractiveness.

When it comes to body size, large or small, poverty has always been a defining factor. Historically, having a lower income often meant you suffered food deprivation and malnourishment. If you were poor throughout much of human history, chances are you were engaged in hard physical labor, all the while experiencing a shortage of food.

In recent times, a counterintuitive reversal of that historical pattern has occurred, particularly in societies such as ours where food has become plentiful and cheap. The “new” pattern is that poverty actually leads to obesity. Studies show that the likelihood of being overweight in the poorest 25% of the population is twice that of people in the wealthiest 25% of the population. Children living in poverty have limited access to healthy foods and greater exposure to high-calorie and fatty “junk” food. Supermarkets are scarce in poor areas and the gap is usually filled with fast food restaurants and convenience stores.

If I were poor, I might also have a harder time being physically active. I might not have discretionary income to join a health club. My neighborhood may not be safe or otherwise conducive to exercise, or I may have to hold two or even three low-wage jobs to support my family, leaving me with little or no leisure time. My child’s school may lack the necessary facilities and have fewer organized sports. Neighborhood safety issues might prevent students from walking or biking to school.

In sum, there are many social and economic conditions that play a defining role in children’s health, including childhood obesity.

Trying to change the behavior and choices at the level of an individual child and family is certainly necessary. However, solutions to such intractable socioeconomic problems as overweight in children must go beyond that. They must include interventions at the level of these same social and economic conditions that are the root causes of poor health.

Children’s healthcare organizations such as Children’s Hospitals and Clinics of Minnesota are uniquely positioned as leaders of multilevel changes necessary to achieve health in children. Our substantial clinical expertise is at its highest impact when it’s leveraged through community partnerships and positive influence on policy and systems change.

A creative recent example of community partnership that comes to mind is a small urban garden program that Children’s TAMS ran last summer.  Six young people worked with a Latino Health Educator to plan, plant, tend, harvest, cook and enjoy the fresh food that they grew themselves in a community garden plot in our neighborhood.  It engaged these youth in healthy physical activity and community connectedness, while teaching them life-long skills that promote healthy behavior.   The program was based on the innovative local Youth Farm and Market Project.

Boris Kalanj is the Director of Health Care Equity and Cultural Competence at Children’s Hospitals and Clinics of Minnesota. Read his bio.

Are you sick? You should be.

Stethoscope Did you ever notice that if you watch commercials, 50% of them seem to be oriented to some medical problem? Heck, if you watch the nightly news, 90% of the commercials have to do with some medical problem. Whether your leg is restless, you have ED, ADD, OCD, constipation, diarrhea, severe menstrual cramps, headaches, backaches, bloating, allergies, acid reflux, asthma, emphysema, or you need a wheelchair, you can’t get by without some drug.

I’m beginning to believe that to be normal you have to have an illness. In fact, I doubt there is anybody out there right now who doesn’t have something that they would consider a chronic problem. Now I’m not saying this to be cynical about the people with “real organic illnesses” and many of these other things are symptomatic and real, but at some point we have to ask ourselves, is there any symptom we have that we don’t think about as being a disease? What does it say about our society? What does it say about what we teach our children?

Perhaps this is another reason why health care costs continue to rise when everybody says they need to feel great and perfect at all times. Just my thoughts for the week and now I need to get my knee looked at by my orthopedist.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.

Being a grandpa cool enough to blog

Social Networking When I was asked to be part of the Children’s blog, I got very excited thinking, wow, I’m now one of those up-to-date type of managers. Even as a grandfather, I could be cool because I have a blog. The fact that I even understand some of the manifestations of social media is a little bit mind-blowing (an old term by the way).

When I told my adult children I had a blog and asked if they would read it, my oldest son, a Generation Xer of 32 years of age, sent me the definition from Urban Dictionary (by the way, a site that I highly recommend). Under Urban Dictionary the definition of blogger is:

“Term used to describe anyone with enough time or narcissism to document every tedious bit of minutia filling their uneventful lives. Possibly the most annoying thing about bloggers is the sense of self-importance they get after even the most modest of publicity. Sometimes it takes as little as a referral on a more popular blogger’s website to set the lesser blogger’s ego into orbit.” – Maddox

Well, as soon as I saw this I realized it wasn’t dissimilar from my own feelings when people ask me if I’ve seen their Facebook and read their recent writings. I once told my sister-in-law that while I love her dearly, seeing her 6 to 8 times a year is enough and I don’t need to know what she is doing every day.

Nevertheless, social media is here to stay whether it is Facebook, YouTube, Twitter or the blogs. Rather than being afraid of it, one needs to realize that it is just another technological advancement no different than telephones, the Internet, email, etc. Each one of these modalities just continued to do what the previous one did: allow people to network with others who they consider friends or think similarly to communicate with each other.

Even by the time I write this blog there will probably be some new technology out there that my children will have already started using. Since I realize they don’t call me back and hardly ever respond to emails anymore, I won’t find out immediately. If I’m not texting or tweeting, I’m just not with it.

I bring this up because from a management standpoint, one has to know what the next generations use, think or value if we are to have any success in getting things accomplished. That is, we have to know what technology to use.

In the New York Times on March 14, there was a small article in the paper about a professor and other teachers taking away cell phones and computers for one week from their students to see what they’d be able to do without them. For most, it was a major struggle. For me, not having my Blackberry would be a major struggle. Nevertheless, they are here and there will be more and for those of us who want to work with other young doctors and other young staff, we will have to learn to adapt to them and with them. Tweet away.

Why do you think it’s important for health care professionals to stay on top of new communication trends?

Phillip M. Kibort, MD, MBA, is the Vice President Medical Affairs/Chief Medical Officer at Children’s Hospitals and Clinics of Minnesota. Read Phil’s full bio.

Introductions: Boris Kalanj

Dr. Culbert With a Patient Did you know that more than 50% of patients who seek care at Children’s are nonwhite; 20% speak a language other than English in the home; and greater than 40% are from low-income families, insured through Medicaid?

In this blog, I will write about these and other groups who are often referred to as “underserved” – lacking either in access to health care, its quality, or both.

I will explore some of the social issues that help define Children’s in our community.  You can expect me to write about health care disparities – differences in quality and outcomes of health care due to personal characteristics such as ethnicity, primary language, location, and socioeconomic status.  I will also write about cultural competence and attention to diversity in health care organizations as some of the key methods for reducing disparities.  There are many topics that can be discussed in this context, and I look forward to hearing about issues that particularly resonate with you.

I started at Children’s nine years ago as manager of its then-nascent program of interpreter services.  Over the years, my role has evolved into responsibilities for broader organizational cultural competence.  Currently, as Director of Health Care Equity and Cultural Competence, I collaborate with others to identify, understand and eliminate health care disparities, particularly within care provided at Children’s. Continue reading

Frustrations with healthcare reform

Dr. Phil Kibort

From my perspective, it has been a frustrating few weeks.

The number one reason for my frustration is the country’s lack of courage in doing anything about healthcare reform. Now, I’ll point out to you that I’m a bleeding heart liberal. At the same time one of my hobbies, my main hobby in fact, is studying American presidential history. Knowing it as I do, I don’t get as upset when there is partisanship and infighting in Congress. Having the perspective that when the country is ready for things, it does take action.  Unfortunately, it’s usually crises that make us take action, whether it was the Civil War, Pearl Harbor, Kennedy being assassinated leading to Lyndon Johnson being able to create a lot of reform, Katrina, and of course 9/11.

I don’t know what it will take to get the country to realize what a catastrophe we have right now without healthcare reform.

For 17% of the gross domestic product it continues to rise by a quarter percent per year.  It will make our country absolutely noncompetitive in the world market. What’s frustrating is, one party tries to do one thing and the other just opposes it regardless or one party declares “let’s start from scratch,” when we all know that the lobbyists for the insurance companies and those who benefit by keeping the status quo do everything in their power to keep it as-is.  This is done regardless of the fact that we all know how much waste there is in healthcare and how our total outcomes compared to other developed countries is only average. Continue reading