By Lincoln Cushing, Heritage writer
Health is a Human Right: Race and Place in America September 28, 2013 – January 17, 2014
This exhibition examines some historic challenges of the past 120 years in achieving health equity for all in the U.S. We know that “race and place” are as important as personal choices in achieving our full potential. People with low-incomes, minorities, and other socially disadvantaged populations face significant inequities in opportunity for optimal health. This can lead to inequities in health, along the lines of race, ethnicity, and place.
From the exhibition introduction:
As this year marks the 25th anniversary of CDC’s Office of Minority Health and Health Equity, it is timely to reflect on the evolution of minority health over the last century. Looking back at how minority groups have experienced health problems differently helps us understand “why” these disparities persist. Though we have not yet been able to achieve our goal of the best health for all, we have as a nation made important strides in identifying the problems and implementing solutions. There is still more to do, and this historical reflection helps us examine what other vital changes are needed.
In addition to viewing historic photographs, documents, and objects, visitors can check up on the health of their communities through interactive atlases. Videos, including one of Michelle Obama talking about access to fresh food and vegetables, will be integrated throughout.
Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia 30333
Short link to this story http://ow.ly/qyoFE
By Lincoln Cushing, Heritage writer
In January 2011, Kaiser Permanente launched the “Every Body Walk!” public awareness campaign. Chairman and CEO George Halvorson kicked off the initiative in his weekly celebration letter to all employees and physicians on January 14, 2011:
“It is time to celebrate walking. There are very few things that we can do that have a more positive impact on our health and our lives than walking. . . Kaiser Permanente is on a new path, so to speak, to encourage everyone in America who can safely walk, to walk. The theme is — Every Body Walk!”
Walking a prescription for health
Bob Sallis, MD, family physician at Kaiser Permanente Fontana (Calif.) Medical Center and the national spokesperson for the campaign, described the goals for Every Body Walk:
“The aim of the campaign is to inform Americans about the tremendous health benefits of walking. Walking is an excellent form of exercise for everyone. For those with conditions like diabetes, asthma, heart disease and depression, a regular walking regimen has the added benefit of helping to manage these diseases.
“I’m a strong believer in the power of walking and that’s why I literally prescribe it to my patients as front-line medicine — often in place of medications.”
From a public health point of view, the campaign is important because it addresses the many people that don’t get what is commonly thought of as “regular exercise” – going to a gym, playing tennis, or riding a bicycle.
Every Body Walk! encourages a modest amount of activity, thus opening up a new path to healthy behavior for millions of people. The campaign provides news and resources on walking, health information, walking maps, help in finding walking groups, as well as a place to share stories about individual experiences with walking.
Research validates value of walking
Medical research shows that walking 30 minutes a day, five days a week, can prevent the onset of chronic diseases, or help manage them. The roots of this prescription can be found in a 1996 report by the U.S. Department of Health and Human Services, Physical activity and health: A report of the Surgeon General.[i]
The research supports the common-sense and empowering notion that some exercise is better than none, and any approach to encourage activity will have positive health benefits:
“Emphasizing the amount rather than the intensity of physical activity offers more options for people to incorporate physical activity into their daily lives. Thus, a moderate amount of activity can be obtained in a 30-minute brisk walk, 30 minutes of lawn mowing or raking leaves, a 15-minute run, or 45 minutes of playing volleyball, and these activities can be varied from day to day . . . Through a modest increase in daily activity, most Americans can improve their health and quality of life.”
Recent studies confirm concept
Subsequent medical research amplified the benefits. A 2002 study by the Centers for Disease Control and Prevention found that patients who ate a healthy diet and engaged in moderate physical activity for 30 minutes a day, five days a week, reduced their risk of getting Type 2 diabetes by 58 percent.[ii]
A 2010 prostate cancer study found: “A modest amount of vigorous activity such as biking, tennis, jogging, or swimming for less than three hours a week may substantially improve prostate cancer-specific survival.”[iii]
Recent research at Oregon State University’s College of Public Health and Human Sciences suggests the health benefits of small amounts of activity – even one- and two-minute increments that add up to 30 minutes per day – can be just as beneficial as longer bouts of physical exercise achieved by a trip to the gym.
The study, which involved a broad demographic of more than 6,000 American adults, shows that an active lifestyle approach, as opposed to structured exercise, may be just as effective in improving health, including the prevention of metabolic syndrome, high blood pressure, and high cholesterol. Lead author of the study, Paul Loprinzi, explains:
“We encourage people to seek out opportunities to be active when the choice is available. For example, rather than sitting while talking on the phone, use this opportunity to get in some activity by pacing around while talking.”[iv]
Garfield walks, jogs in desert
At Kaiser Permanente, innovation is usually framed in the context of deep previous experience. In the mid-1930s, founding physician Sidney R. Garfield, MD, was running a clinic in the Mojave Desert for the workers on the Colorado River Aqueduct project. Guess how the clinic staff stayed fit?
“When we were at the hospital (walking) is what the staff did all the time for keeping fit (and for) exercise, except we’d jog – yeah, we would run, but we’d wait until the sun went down, go out and jog and then would walk along. And about that time the rattlesnakes would come out, and then we’d really jog.”[v]
History is repeating itself, and we’re all the better for it.
See “Gift of Walking,” a short video featuring Kaiser Permanente Chairman and CEO George Halvorson.
Short URL for this story: http://bit.ly/WHcZbv
Reducing the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine has published a new article by Knowler WC, Barrett-Connor E, Fowler SE, et al entitled “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med 2002 Feb 7;346(6):393–403.
By Lincoln Cushing
World AIDS Day – set for December 1 every year – was established in 1988 by the World Health Organization to draw attention to the need for international medical and governmental cooperation in addressing this catastrophic disease.
The WHO adopted one theme for the years 2011 to 2015: “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” One focus of “Getting to zero” has been a global effort to ensure a safe and ample supply of that renewable potion of life – human blood.
In its 67 years of operation, Kaiser Permanente has been an active partner in the ongoing quest to keep blood available and free of dangerous contaminants.
In 1948, three years after the Permanente Health Plan was opened to the public, the Permanente Hospital in Oakland started its own blood bank. It was the only private hospital in the San Francisco Bay Area to offer such a service to patients. The single requirement was that blood recipients had to arrange to replace the blood. Members could give blood ahead of time to ensure availability when they needed it.
KP gets out of blood bank business
By the mid-1960s, however, 80 percent of the blood used in KP’s Northern California hospitals came from community blood banks, costing $25 a pint. KP offered a Permanente Medical Group Blood Transfusion Insurance Program, which credited the donation of a single pint against unlimited blood needed by that member for two years, or one year if applied to a family.[i]
The math worked out – Permanente Medical Group Executive Director Cecil Cutting, MD, noted: “. . . Participants are a relatively healthy lot of members whose transfusion requirements account for fewer than 3 percent of total Health Plan transfusions, while their contributions are running equivalent to 30 percent of the total blood used.”[ii]
In the past four decades, blood bank operators have been faced with the reality that the use of donated blood – its drawing, storing and administering – poses risks for transmission of disease, such as HIV/AIDS and Hepatitis B and C. In 1971, blood banks began to test donated blood for Hepatitis B.
Keeping blood supply safe
In 1983, U.S. blood banking groups issued their first warnings about AIDS. This action was taken after researchers learned HIV/AIDS was a blood-borne disease that could be transmitted by blood transfusion, as well as by sexual contact and shared hypodermic needles.
In 1985, immediately after the U.S. Food and Drug Administration licensed the first test to detect the antibody to HIV, Red Cross Blood Services regions began testing all newly donated blood for HIV. Since then, there have been an estimated 10,000 cases of HIV in the United States resulting from contaminated whole blood administered to patients between 1978 and 1985. (A heat treatment developed in 1985 renders blood plasma safe.)iii
In 1988, the federal Centers for Disease Control notified Kaiser Permanente that community blood banks in KP’s Bay Area service areas had not screened blood donations properly to prevent contamination in the supply.
Kaiser Permanente, not responsible for independent blood bank procedures, contacted Health Plan members who had received blood from local banks between 1978 and 1985. Affected members were told that the risk of transmission of HIV might be higher than the nationwide average due to the blood banks’ improper and inadequate blood screening.
KP encouraged these members to obtain free HIV screening tests. iv The 1985 cutoff date reflected the increased blood screening that virtually eliminated transfusion transmission.
KP has also aggressively reduced other HIV blood transmission risks, such as hospital staff needle sticks, but addressing member risk through contaminated blood was a major first step. The task of addressing the epidemic was huge, but KP took the challenge seriously.
By 2000, a KP Northern California spokesperson could safely affirm: “Our efforts make a difference. Kaiser Permanente is making profound efforts to stop the spread of AIDS.” v
Editor’s note: Heritage writer Lincoln Cushing is a regular blood donor and encourages all readers who are medically able to donate as well. This crucial renewable resource depends on volunteer donors. Blood agencies regularly schedule mobile units at large institutions. Please step up when you have the opportunity.
[i] Permanente Medical Group Blood Program brochure, 1967.
[ii]Newsletter from the Desk of the PMG (Permanente Medical Group) Executive Director (Cecil Cutting, MD), October, 1967.
iv “AIDS Update,” Planning for Health, Fall 1988
v California Wire, 11/20/2000
By Bryan Culp
Heritage Resources director
We cap October with a story for National Breast Cancer Awareness Month, the annual campaign to increase awareness of the disease and raise funds for research into its cause, prevention, diagnosis, treatment and cure.
Did you know that Ernie Bodai, MD, a Permanente surgeon and director of the Breast Cancer Survivorship Clinic at Kaiser Permanente, Sacramento, California, was the driving force behind the creation of the U.S. Postal Service’s Breast Cancer Research Stamp?
Since 1998, post offices in big cities and small towns across America have sold 950 million of these first-class postage stamps. Letter-writers and patrons like you and me have raised $85 million for breast cancer research through the purchase of this special postage stamp. More in a moment about the stamp and its genesis.
The Centers for Disease Control and Prevention reports that in the U.S. alone over 210,000 women are diagnosed with breast cancer every year, and 40,000 women die every year from the disease. It is the leading cause of death from cancer among Hispanic women, and the second leading cause of death from cancer among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.
Good news about breast cancer rates
If there’s any good news in these rather jarring and unsettling facts it is that the incident rate has been declining since 1999 and the death rate since 1990. Early detection, mammography screening, and improved therapies have helped to lower mortality rates.
New knowledge through research offers a brighter tomorrow in the fight against breast cancer. The National Cancer Institute reports that advances in cancer genomics and cell biology are leading to the development of less toxic therapies that are tailored to an individual’s genetic profile.
Analysis of “gene expression,” the process by which a gene gets turned on in a cell to make RNA and proteins, has led to the identification of five subtypes of breast cancer, each subtype possessing distinct biological features and each responding differently to clinical therapies. Also, new knowledge of the immune system led to the development of several promising breast cancer treatment vaccines that are currently under clinical evaluation.
A stamp is born
That people like you and me could help fund breast cancer research of this magnitude through the simple purchase of a postage stamp was a novel idea.
The Breast Cancer Research Stamp, now in its fifteenth year, sells for 55 cents; that’s 10 cents over the current rate of first-class postage. By law, the net amount raised from the sale of the stamp is earmarked for breast cancer research at the National Institutes of Health and the Medical Research Program at the Department of Defense.
The three-year journey from day of conception to the first day of issue began in December 1995. “I was stamping holiday cards and preparing for a lecture on the history of breast cancer surgery,” said Bodai, “when suddenly it occurred to me, ‘Why not have a stamp to raise money for breast cancer research?’
“A quick analysis of the United States Postal Service in 1996 revealed that 180 billion pieces of mail were handled, one third of which were first-class items utilizing a 32 cent stamp. If half of those stamps were sold at 33 cents, $300 million would be generated annually, nearly equaling the entire National Cancer Institute’s budget for breast cancer research.”
Bodai contacted Postmaster General Marvin Runyon who tersely rejected the idea on the grounds that the U.S. Postal Service was not a fundraising organization. Bodai then solicited members of Congress proposing legislation to authorize the stamp. He received no replies.
Surgeon cuts through red tape
So he brushed-up on how Congress works and off he went to Washington. He lobbied the 48 women in the House of Representatives and 11 women in the Senate. He started a grass roots campaign and earned endorsements from prestigious organizations including the American College of Surgeons and the American Medical Association. He won over legislative champions Sen. Diane Feinstein (D-CA) and Rep. Victor Fazio (D-CA) who sponsored and shepherded bills to authorize the postage stamp.
In July of 1997, the ‘‘Stamp Out Breast Cancer Act’’ passed the House (422-3), and a similar version passed unanimously in the Senate. President Bill Clinton signed the bill into law (PL 105-41) in August 1997.
With the passage of the law the U.S. Postal Service needed a stamp. Art director Ethel Kessler and illustrator Whitney Sherman were commissioned for its design.
Sherman says of her work, “After many sketches, one idea was taken to final review, the image of Artemis, the Greek goddess of the hunt.” Sherman found in the Artemis of classical depiction, bow in hand and with a quiver slung over her shoulder, “a figure larger than any single nationality, race or age.
“After developing the line work of Artemis reaching back for her arrow, I realized she was mimicking the stance taken when doing a breast self-examination.” This was an unexpected “visual bonus.”
Kessler, a breast cancer survivor, added the cheerful, vibrant colors and the slogan “Fund the Fight. Find a Cure” to evoke hopefulness and spirit for battle. The stamp debuted in July of 1998 in Los Angeles.
The winter holidays are upon us and soon we’ll be mailing cards to family and friends. When you drop by the post office for that cache of stamps, consider the Breast Cancer Research Stamp. For just a few cents more you too can “fund the fight to find a cure.”