Speaker: The system's pretty good, the expectations are crazy
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I suppose it all depends on how much you also spend on palliative care then because people in pain and their relatives tend to shout very loudly and get political attention whereas toddlers in Porirua and their parents, not so much. So when someone's Nana needs a hip replacement and has been waiting for 2 years in increasing pain and disability it is hard to ignore that or be sanguine and philosophical about it.
It also depends on what people do with those extra healthy years, if they keep the weight off, eat right and exercise then they will reduce their ill health burden, on average in later life. There is truth in the old adage of use it or lose it, joints wear when the muscles around them are not strong enough to hold them in ideal positions. This comes from being constantly and well active. So primary care and early intervention is only one plank. The hard one will be to encourage people to ditch the computer, the tv, the games console etc and exercise, which will mean more than a brisk walk around the block too.
For the record I'm 44 and I run 55-65km per week and eat a pretty healthy diet, I obviously don't smoke and drink very moderately (unpleasant running on a hangover).
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We need a system that impartially draws the line where public health treatment ceases because it is too expensive to keep a person alive for too short a time.
Oh my god. It's a Death Panel (TM)!
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For the record I'm 44 and I run 55-65km per week and eat a pretty healthy diet, I obviously don't smoke and drink very moderately.
You're planning to be one of those people who lives forever and breaks our superannuation bank, aren't you? For shame!
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3410,
For the record I'm 44 and I run 55-65km per week and eat a pretty healthy diet, I obviously don't smoke and drink very moderately.
If only we had some sort of Health Credit Trading Scheme.
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Slightly more seriously, the crude economism of "but people should look after themselves to be deserving to receive health services" gets up my nose quite a bit. My father smoked and was fat. Yet he was never sick, he just dropped dead at 64. Paid lots of taxes, received no pension - he was a bloody boon for the state coffers. i've got nothing against people who live longer because of their healthier choices, all power to them, but during those extra 20-30 years of life they are going to be riddled with expensive ailments, regardless of how much they've looked after themselves at 44 (in fact, if they've run a lot I'm going to pick their knees aren't going to be too good.)
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If only we had some sort of Health Credit Trading Scheme.
Genius.
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You're planning to be one of those people who lives forever and breaks our superannuation bank, aren't you? For shame!
Nope. With my familial inheritance I intend to be a bright burning comet, to be fit enough so that when the decline comes it comes swiftly and decisively. I am pessimistic about drawing a pension at all, let alone for a long time.
The real reasons I run are:
1. I enjoy it (no really, I just love it)
2. I'm addicted to my own endorphins (I have to restrain myself from running on my rest days)
3. I feel absolutely fantastic
4. I like the challengeBeing fit and not being sick don't really factor. Though when I had swine flu recently it took me a while, in fact after the peak, until I realised what I had. My main symptom was a complete and utter loss of energy and that is about it. Though at its peak I didn't have the energy to sit in a chair. According to New Scientist people who exercise regularly experience the mildest symptoms. So I'm not complaining about the health benefits either.
My only visit to the doctor in the last year was for a new inhaler, I get a bit wheezy on those dry, really cold winter days. Hard to run like that. Reminds me, must check the one I have is still in date.
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If only we had some sort of Health Credit Trading Scheme.
"20 laps of the Olympic-length pool gives you one credit: a subsidised nurse appointment for your cervical smear, to be used within the next six months."
I think primary care and preventative care are great things, of course, but I get a little dubious about how far the preventative aspect will eventually go. That Victorian idea of the 'deserving poor' seems to have been shifted sideways in the health system, and now people are supposed to be 'deserving of care' (or not, if they watched too much telly and smoked Holidays). People are just as precious to their own friends and family whether they 'look after themselves' or not.
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If only we had some sort of Health Credit Trading Scheme.
hmm, a discount on my tax (or over here, National Insurance) would be welcome. The problem is of course that while on average, doing what I'm doing will reduce my ill health burden on society, that doesn't mean it will be the case in my particular case.
Instead govt taxes those things that are known to be very bad for us, ciggies and alcohol. Of course they should also be doing it for overly sweet or fatty foods too and using the income to subsidise healthy food.
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In terms of the post itself, yay for primary health care, and by all means I'm not suggesting we shouldn't reduce obesity or promote healthier eating.
Not sure why the Remuera nonagenarian had to be a spinster, but that's a quibble.
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And I don't know about NZ, but over here they offer everyone over 50 statins routinely. Which is as big an admission as you are ever going to get that govt has given up on the idea that people can be persuaded to look after themselves properly. I do not intend to take them since I am persuaded about the benefits of looking after myself and I prefer the side effects of running to the side effects of taking statins every day.
Actually I should modify my reasons to run. I started to run again in middle age (I ran a LOT in my youth) after the GP gave me pills to take every day to deal with my heartburn. I was a bit taken aback that he did not even mention I could do with losing a bit of weight. The pills worked but I didn't want to be someone who took a pill every day for the rest of my life, first one then two, then even more. So when I finished the course, instead of going back for more I strapped on my running shoes, hit the road and watched what I ate. The weight dropped off, the heartburn stopped and I got hooked again. The list above is why I run now. This was why I started to run again.
It's cold and WET here in Eastern Scotland, but that only determines what I wear when I run and whether or not I wear my glasses (no point in the rain). Only really icy conditions will stop me, frost won't, that crunchy frost is fine to run on. Dry snow is great to run on and I am not soluble so rain is no problem.
if you see in the news 'runner dies of exposure on city street in Scotland', that will be me ;-)
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The high costs of the privatised US health system (which President Obama is trying to steer away from) owe a lot to the malpractice litigation industry over there. And also largely unique to America, it's also had a knock-on effect on its heavy industry sector too, in the form of union healthcare plan demands.
Those who wish for private accident insurance and a return to the CHE system (or worse) should be careful what they wish for. They might actually get their wish.
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And I don't know about NZ, but over here they offer everyone over 50 statins routinely. Which is as big an admission as you are ever going to get that govt has given up on the idea that people can be persuaded to look after themselves properly.
Peter, not everyone is able to lose weight, for a variety of reasons. Most people at the end of the day are going to get the statins.
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Not sure why the Remuera nonagenarian had to be a spinster, but that's a quibble.
Because if the little old lady didn't get married or have children, she's *worth less*. We all know this! (Meh.)
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...and former treasury analyst Geoff Simmons...
You mean someone who worked for the organisation of which was said (to quote our glorious leader):
"Treasury can’t tell us what the deficit is going to be in December let alone what’s happening in 2030 or 2040"??
That Treasury?
After that I read that I decided there were to many words in the article. -
Actually Giovanni, I wouldn't worry about my knees. That recent paper didn't actually measure osteo-arthitis, it measured damage. I bet if you looked in my knees you would see damage. That is because last night I ran up, and down, a very steep hill (1 in 9 gradient 450m long) 10 times. But I heal as well. None of which means My joints are prone to either osteo-arthritis (I also have no family history, at all) or need joint replacement (you should see the size of my thigh muscles, well able to hold my knees together).
Actually I have no knee pain at all, not in the joint that is, my problem is those muscles. My vastus medialis accessorius muscles keep playing up. not enough to be a problem, just an annoying niggle. My rule is if it hurts at the bottom of the hill I keep going, if it stops I forget it. If I listened to my knee muscles I would never run, but they are all mouth and no trousers.
The joys of the ageing athlete.
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(nb; haven't read the book... perhaps this is addressed there)
Why offer up a false choice between options/call for 'hard choices' (needed because of a tight public purse) - solely within ONE aspect of state funded social care? Why not propose a choice* between (say) more roads and better health care?
Is it all to do with prioritisation? I think it probably is... although the champagne tastes/beer budget observation does hold... we don't want to prioritise... we want it all.
greedy little buggers.
*choice may actually mean 'sliding scale'
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Well that was quite a funny snippet of Gareth's thinking.
It vacillated between PR for primary and preventative health care and having a good old dig at whiny rich people, well they must be richish enough to have a computer and the ability to go to "hypochondria.com", I would have thought "miraclecure.sucker" would have been more appropriate.
Ya know, (chuckle) it's funny because over on Keith Ng's blog some one was having a whine about poor people knocking the rich. The phrase "tall poppy" put in an appearance. Any way any way..
It occurred to me that what was going on here is the poor people will moan about the rich people, but will stoically take their hit's when it comes to their health, or look after themselves because if they don't all they can do is sit on their arse's, eat Mickey D's, watch TV and fat.
Whereas the rich people will stoically takes the jibes about their wealth, we all get to see this on our TV's, fit and fat. But these...... how can I say this...... rich people moan like shit when they get old, sick and are dying. And it seems search the internet and bug their doctors , who are willing to sit and smile as their bank accounts tick over.
Ohhh New Zealanders you have come to a sorry state.
But that chap in Bangladesh what a guy.
When's he coming back... I miss him already. -
Because if the little old lady didn't get married or have children, she's *worth less*. We all know this! (Meh.)
I'll let the authors talk to their reasons for inclusion themselves, but I think this is just the attempt to use extremes to make the point. The "imagery" of someone late in life without family taking a significant portion of the health budget over the young toddler of Porirua (was it?) not getting vaccinated is the attempt to show the extremes of the social outcomes.
I think you would be hard pressed to actually make numbers of direct family members an actual driver of health spend, and I also don't believe they are trying to do so.
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Peter, not everyone is able to lose weight, for a variety of reasons.
I will be first in the queue to argue that you cannot blame people for their obesity. However it is not true that not everyone can lose weight. Even without exercise, an awful lot of it is down to modern diets and its way, way too many empty calories.
Prof Colin Palmer here in Dundee, a former boss of mine did a study on obesity in 9-10 yo primary kids analysed by socio-economic status. They found that obese poor kids are 1cm shorter on average than obese middle class kids. That may not sound like much but its more than the difference between girls and boys at that age and is very highly statistically significant. They are 'malnourished in the face of plenty' as the paper put it.
That is true of much of our modern diets. Good food is expensive. The supermarkets discount stuff that is bad for you, two for one on bags of chips. Cheap ready meals packed with fat and salt are lots cheaper than the healthier alternative. Look next time you are in the supermarket at the sort of foods that are on special.
If people ate properly, ate good calories, which are also low GI and so fill you up and keep you full by dribbling glucose into your bloodstream instead of in one big splurge then they would eat less and so lose weight. It is not rocket science.
The hard part is that society is filled with inducements to do the opposite and we are opposed by our biology. Food high in sugar and fat are high value when you are a hunter gatherer. Peoples who still are will do a lot and risk a lot for honey for eg. So our tastebuds are evolved to favour those foods. That is why a chocolate eclair tastes so good.
So when we live in a society where it is cheap to produce food laced with sugar, salt and high in fat and fesh vegetables and wholegrain bread are expensive eating right becomes hard, especially on a budget. When supermarkets in low decile areas are both few and far between and don't even bother stocking decent food then people don't even have a practical choice.
Those are the reasons it is hard to lose weight, because we are conspired against by powerful interests which make the solutions hard to achieve for many. Not because in the absence of all those it would be hard, or for some basic biomedical reason.
Obesity is a modern phenomenon, people have not changed in the last 30 years (I remember the '70s when everyone was thin). So it cannot by some ineluctable biological barrier that prevents weight loss or prevention of weight gain.
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Anyway, fascinating as this is. It's nearly half past midnight here. Good night, see you in the morning.
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Obesity is the modern world's take on the mind-body problem. Not a new take, I think.
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then they would eat less and so lose weight. It is not rocket science.
I know I am going to regret this, but that is currently, unless we create some magic bullet, false. Once you are a fat person it is HUGELY unlikely (perhaps 95% unlikely?) that you are going to lose large amounts of weight and keep it off permanently. (See the general review of long-term controlled-calorie dieting trials in American Psychologist 62, 3, April 2007, pp. 220-233.) Once someone is obese, it's close to pointless to concentrate on weight loss. We *should* be concentrating on diet, and on exercise, but those things will only improve the health of fat people, and perhaps prevent obesity in kids or non-obese adults. But those measures will probably not cause already-obese people to drop significant pounds.
(I remember the '70s when everyone was thin)
WTF? I remember the 70s too. I cannot express more emphatically that NOT everyone was thin.
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Obesity is the modern world's take on the mind-body problem.
I always say it's a glandular problem. The pineal gland, to be precise.
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There is both a strong genetic and strong diet component to obesity.
It is patently not possible for obese people to "simply" change their diet or even "simply" change their exercise habit.
Most of the successful treatment of obesity now focuses on treating the patients lifestyle over periods extending to decades. Which coincidentally requires really good primary health care.
The best successes come from essentially treating obesity as an addiction and there is increasing evidence that it may be precisely that. Once a person has adapted to eating larger quantities of food they become addicted physiologically.
Much the same way people who exercise too much become addicted to the endorphins.
Sorry for characterising obesity as a disease/disability that language isn't ideal but in the terms of the discussion it seemed appropriate.
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