The increased importance and fast rising costs of healthcare in the US and many other countries are causing a much greater interest in the subject of public health - “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.”
We are all very familiar with the fierce political debates surrounding US healthcare reform, which culminated with the historical Health Care Act of 2010 signed into law by President Obama on March 30. But healthcare is not only a major political challenge, but one of the grandest overall challenges facing the world in the 21st century.
The problems are enormous at multiple levels. Healthcare involves lots of people and institutions - patients, insurers, device manufactures, pharmaceuticals, advocacy groups, biotech, research institutions, IT companies, governments of all sorts, state licensing, state insurance commissioners, and on and on and on. And this is before you get to the provider side, which involves doctors, nurses, hospitals, pharmacies, non-traditional providers, medical schools, and others.
Most experts agree that the only way to make progress in such a complex, grand challenge is to approach healthcare as a system of systems. This is particularly true of public health. But, fortunately, we also have more technologies, innovations and ideas than ever at our disposal to do something about these problems. We can leverage our major advances in science and technology to try to improve the health of entire communities through sophisticated, smarter population health innovations. We can begin to design the overall healthcare system with the objective of keeping everyone as healthy as possible, as well as offering them effective, high quality treatment at affordable costs when they need it.
Earlier in May, IBM launched a major research effort to help us bring our most advanced science and technology to the most challenging public health issues, The project, codenamed SPLASH and centered in IBM’s Almaden Research Lab, will bring massive computational and information analysis capabilities to government agencies, health care providers and companies to help them improve the overall health of the communities they are responsible for. In its press release, IBM said:
“The IBM Research project will combine and analyze massive data sources that have never before been integrated to simulate the cause-and-effect relationships between agriculture, transportation, city planning, eating and exercise habits, socio-economic status, family life, and more. Predicting real-world reactions that influence human health, the project aims to provide fact-based recommendations of actions to take and ones to avoid.”
There are a number of areas where analysis and modeling of existing public health data can help healthcare providers and government agencies develop better strategies. The new IBM initiative will initially focus on one of the most important such areas, childhood obesity. According to the Mayo Clinic:
“Childhood obesity is a serious medical condition that affects children and adolescents. It occurs when a child is well above the normal weight for his or her age and height. Childhood obesity is particularly troubling because the extra pounds often start children on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol. Childhood obesity can also lead to poor self-esteem and depression.”
Childhood obesity is an excellent example of the kind of chronic medical conditions that must be dealt with beyond the traditional healthcare system. Many factors are directly linked to childhood obesity. Some like the wide availability of processed foods and lack of exercise are widely acknowledged. However, childhood obesity is also affected by the family situation, economic conditions, neighborhoods, food retailers, education, genetics, advertising and several other factors. In order to develop effective programs to combat this chronic condition we must understand the complex interactions of all these factors, based on the best available data.
The week before the announcement of the SPLASH initiative, IBM hosted a conference on Smarter Health through Modeling and Simulation at the Almaden Research Lab. The two-day conference included about 200 experts in different health-oriented areas, as well as in information analysis and modeling.
I moderated a panel, On the Front Line of the Food Revolution with two excellent speakers, Dr. Tenley Albright, Director of MIT Collaborative Initiatives and member of the general surgery faculty at the Harvard Medical School, and Fedele Bauccio, co-founder of the Bon Appetit Management Company.
In her presentation, Dr. Albright mentioned that the total costs of dealing with obesity-based health issues in the US were almost $150 billion in 2006. These figures are bound to go up in the future, as the percentage of obese children between the ages of 6 and 19 has gone up more than three-fold in the last forty years.
There is only one reason for the increase in obesity, namely the imbalance between the calories taken in as food and the calories spent in energy output. This imbalance results in weight gain. Over the last thirty years, there has been a significant increase in the calories consumed per person per day, leading to childhood obesity rates of epidemic proportions.
While many groups across the country are working to address this epidemic at local and community levels, there has been no overall public health initiative helping to better coordinate all the various approaches to the problem. For example, since a major reason for the increase in calorie consumption is the wider availability of processed foods and sugar-based drinks, it is difficult to address the childhood obesity epidemic without dealing with the food supply system, and in particular, the scarcity of affordable, healthy foods in poorer neighborhoods.
Fedele Bauccio talked about Bon Appetit, the food company he co-founded in 1987 whose motto is food services for a sustainable world. Bon Appetit provides catering services to corporations, colleges and universities, with over 400 locations in 29 states. In its website, the company writes:
“Our Dream is to be the premier onsite restaurant company known for its culinary expertise and commitment to socially responsible practices. We are a culture driven to create food that is alive with flavor and nutrition, prepared from scratch using authentic ingredients. We do this in a socially responsible manner for the well being of our guests, communities and the environment.”
Bauccio believes that the food and health systems are intimately linked, not only with regard to obesity, but also environmental impacts, antibiotic resistance, contaminated foods and animal welfare concerns. For example, the US Center for Disease Control estimates that every year, 76 million Americans get sick from eating contaminated food, more than 300,000 are hospitalized, and 5,000 people die.
The answer, Bauccio believes, is to move away from our current industrial agriculture model, - based on agrochemicals, federal subsidies for feed crops, high dependence on fossil fuels, and no respect for the health of the soil, - to an environmentally sound, economically viable and socially equitable ecological model.
This will be very, very difficult. We will need to convince a major portion of society that the food system, obesity, diabetes and other health issues, and high health costs are closely intertwined and represent a serious public health risk. But as I thought about it, the challenges involved in addressing the childhood obesity epidemic reminded me of the evolution in thinking between smoking and health that I have personally observed over the past several decades.
Fifty years ago cigarette smoking was portrayed as something glamorous and cool. Many people smoked, as so vividly depicted in the television series Mad Men, including pregnant women. Even though evidence of the ill effects of smoking had already started to accumulate in the 1930s, 1940s and 1950s, a 1958 Gallup Survey found that less than half of all Americans believed that smoking caused cancer.
Attitudes toward smoking started to change as the scientific evidence accumulated, and in particular, with the publication of the 1964 Surgeon General Report on Smoking and Health. This report hit the country like a bombshell. It unequivocally highlighted “the deleterious health consequences of tobacco use,” including a 70 percent increase in the mortality rate of smokers over non-smokers; a nine- to ten-fold risk of developing lung cancer compared to non-smokers; the most important cause of chronic bronchitis, emphysema and coronary heart disease; and so on.
Over the years, the evidence of the impact of tobacco on health has continued to accumulate. Tobacco is now viewed as the single greatest cause of preventable deaths in the US and around the world. It is widely accepted that smoking has a major negative economic impact on individuals, families and society due to the higher costs of health care and lost productivity it causes. In the late 1990s, the tobacco industry agreed to reimburse the states for their tobacco-related healthcare costs as part of a master settlement agreement.
Advances in technology, information analysis and modeling should now make it easier to scientifically establish any links between major public health issues and their causes. Hopefully, the increased sensitivity to corporate social responsibility will encourage the companies involved to collaborate in both identifying the problems and recommending suitable solutions. Initiatives like SPLASH will provide invaluable help by bringing the best possible science and technology to bear on these highly complex, public health issues.