In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.
Dr. Val: What role could consumer-directed healthcare initiatives play in helping to reduce healthcare costs associated with chronic disease? Is the government doing enough to support this movement?
Dr. Carmona: I think the consumer-driven initiatives struggle for a number of reasons, and the most important one is that we’re a health illiterate nation. Studies show that about one third of our population doesn’t understand the connection between their lifestyle and their health outcomes. Consumer-driven initiatives are predicated on the assumption that the consumer can understand the issue and take appropriate action to change behavior.
Are we doing enough? No. The government could pour all of its budget into patient education, but if the people don’t receive a message that they can understand and act upon, we’re wasting our time. The real challenge for consumer-directed initiatives is to deliver health literate, culturally competent messages that resonate with diverse populations. If I sent a bunch of posters to certain communities with a picture of the Surgeon General saying, “eat less and exercise more” would that change behaviors in that community? No. What we need to do is partner with community leaders, whether it be a priest or a rabbi or a grandmother or a block neighborhood captain – someone who has credibility in that community and work with them and spend the time necessary to change the culture.
The American public wants the best of everything, they want it yesterday, and they don’t want to pay for it. That pretty much characterizes the problem that we have. We see health as a right, we want somebody to give us a card, and if we want to smoke, that’s our right too. There’s this attitude that if we want to drink excessively, that’s our right, and if we want to ride a motorcycle without a helmet, that’s our right (“you can’t tell us what to do”). However, when I crash my motorcycle and I have a head injury and I’m disabled for life, I also expect society to pay for that.
We have to do a better job of improving health literacy so that American people of all socio-economic strata can understand the consequences of the choices that are deleterious to their health and help them to adopt appropriate behaviors that optimize health and wellness. Health literacy is the currency of success for everything we need to do to improve the health, safety, and security of our nation. It’s part of what we include in every project we do at Canyon Ranch Institute, with all our partners.
Dr. Val: And how do we get the message across to them, then?
Dr. Carmona: Boy, people have written books on that one. I’ve been plagued by this question, Val, ever since I came into the office of Surgeon General. I remember one day sitting down with my staff and taking a look at the previous Surgeon General reports. I thought they made pretty good book ends and looked nice in my office, but I wanted to know what we used them for. One staff member said, “Well sir, these have been developed to define the base of knowledge on a given topic and it helps our peers decide what needs to be done. It has a long bibliography and it’s based on science.”
But then other staff told me, “Really these are written for the public, so they’ll understand the information.”
And I thought to myself “I don’t know that any of the ‘public’ that I grew up with could read this.”
So I started a program to help communicate health messages to the American public. The goal was to develop resonant messages that would result in maximal behavior change over time. My advisors told me that the messages had to be written at a sixth grade level. So what we did with every Surgeon General’s Report and every Surgeon General’s Call to Action and other publication – we published the “Peoples’ Piece” to go along with it. It was full of pictures and written like a comic book to facilitate parent-child dialog about health. We also wrote them with cultural sensitivities in mind. The science behind our recommendations doesn’t change, but you have to send out thousands of messages to resonate with people from different cultures and languages – who are all Americans – in order to change their behaviors. So that’s what makes this so difficult.
Dr. Val: How do you get the ‘Peoples’ Piece’ to the people? Do you use the Internet or new media approaches?
Dr. Carmona: Unfortunately it’s often the case that the people who need the information the most don’t have Internet access. But the Internet can be incredibly powerful. For example, Dr. Francis Collins (the head of the human genome project at NIH) helped me with the U.S. Surgeon General’s Family History Initiative. We put our heads together to help people understand the significance of family health history.
We put it on the Internet and also distributed it to libraries, post offices, community centers, and schools. It helped people to create a family health tree to use as a talking point with their doctors. They could remind their doctors that, for example, their aunt and grandmother had breast cancer and then ask if they should be monitored more closely. Or they could discuss the fact that their uncles and cousins all had heart attacks before age 50. This tool helped people to begin identifying their risks based on a good family history – which busy docs don’t pay enough attention to anymore. When you know your history, genomics becomes valuable. If we can characterize disease, then we can search for potential genetic loci to help explain what’s going on and take a preventive approach to modifying the person’s environment to mitigate risk.
This concept is extraordinarily hard to communicate, but the Family History Initiative helped to make it accessible to people. We released the project at Thanksgiving time – when we knew that families would be together and could discuss their health histories, and it was a resounding success. Within a week or two we had hundreds and thousands of hits, with people asking for more information.
The Surgeon General series: see what else Dr. Carmona has to say about…