The Immediate vs the Important

McGinnis, J. Michael; Foege, William H.

doi:10.1001/jama.291.10.1263

Cited by 36 publications

(17 citation statements)

References 10 publications

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“…4 Even in managed-care organizations, which presumably offer uniform access to care, there are documented disparities in access, asthma outcomes (numbers of hospitalizations and emergency department visits), and quality care indicators (referral to a specialist and use of antiinflammatory agents where indicated). [5][6][7] Although the structural aspects of the health care system make only a modest contribution to health outcomes overall, 8 several components of the delivery system, such as having health insurance and a usual source of care, have been associated with better asthma outcomes. [9][10][11] SYSTEMS CHANGES TO ADDRESS ASTHMA AS A MULTIFACTORIAL DISEASE Although most of our efforts have focused on therapeutic approaches and on the delivery of care, we need to understand that what affects childhood asthma goes beyond the health care system.…”

Section: Systems Changes In Asthma Management and Access To Carementioning

confidence: 99%

State of Childhood Asthma and Future Directions Conference: Overview and Commentary

2009

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The Merck Childhood Asthma Network, Inc conference titled "State of Childhood Asthma and Future Directions: Strategies for Implementing Best Practices" was held December 13 to 14, 2006. Here we summarize the presentations and recommendations for systems approaches from that conference and discuss current asthma care. Pediatrics 2009;123:S211-S214 T HE ARTICLES IN this supplement summarize the presentations and recommendations made at the Merck Childhood Asthma Network, Inc conference titled "State of Childhood Asthma and Future Directions: Strategies for Implementing Best Practices," which was held December 13-14, 2006, in Washington DC. In addition, they explore the multidimensional array of issues related to asthma causes, epidemiological features, and care, as well as highlighting a series of new and missed opportunities to improve the quality of life for children with asthma. As we discuss, our current system for treating childhood asthma can be aptly described by the adage, "the system is perfectly designed to get the results that it does." We conclude that improving asthma outcomes for children requires taking a more systematic approach that includes implementation of evidence-based, highquality care. Given the prevalence of childhood asthma and its associated burden, implementing a systems approach to preventing the disease and improving outcomes for children with asthma ought to be a national priority. To start, we need to consider what the system would comprise. SYSTEMS APPROACH TO DISEASE PREVENTIONAny serious attempt at system change begins with measurement, which suggests that we need a reliable surveillance mechanism that can measure asthma incidence and prevalence and identify geographic and population-level patterns ("outbreaks") or increases in morbidity in an actionable time frame. Such data need to be collected and evaluated not only on a national scale but also for individual states and communities, because many of the factors that are related to asthma outcomes can be influenced by local action. Although funding from the Centers for Disease Control and Prevention to develop and to implement multiple local surveillance efforts 1 is a step in the right direction, significant additional funding is necessary to develop a comprehensive public health approach that can achieve positive effects. Since 2001, the United States has made significant investments in surveillance systems for bioterrorism agents and pandemic influenza. Many of these systems use emergency department and inpatient claims data or school absenteeism data; the fact that these data sources are not also used to monitor asthma morbidity is a missed opportunity for asthma surveillance.In 1999, the Centers for Disease Control and Prevention undertook an initiative to monitor and to control childhood asthma. The resulting surveillance data came from a combination of survey and hospital discharge data. If expanded and made more timely, these data could be suitable for monitoring progress in asthma prevention and management. As i...

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Section: Systems Changes In Asthma Management and Access To Carementioning

confidence: 99%

State of Childhood Asthma and Future Directions Conference: Overview and Commentary

2009

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“…In a commentary on the importance of preventive health behavior, Schroeder [4] highlighted data originally published in 1993 by McGinnis and Foege [5] indicating that 40% of premature deaths are accounted for by ‘behavioral patterns’. Updated figures suggest that the breakdowns have not changed appreciably [6,7], and we continue to face a dire situation with regard to the necessity of preventing the chronic diseases that result from unhealthy behavior [4,8]. Indeed, approximately 75% of all current healthcare costs in the United States (USD 1.5 trillion) are spent to ameliorate diseases and health problems that are preventable by behavior change [8].…”

Section: Introductionmentioning

confidence: 99%

The Role of Genomics in Health Behavior Change: Challenges and Opportunities

Bryan

Hutchison

2012

Public Health Genomics

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The most common causes of morbidity and mortality in the western world can be accounted for by unhealthy patterns of behavior (e.g. smoking, sedentary lifestyle, unhealthy diet, and alcohol consumption). Interventions to improve health behavior are sorely needed. To fully realize the potential of health behavior change interventions, be they individual level, community level, social structural, or policy-based, a greater understanding of the extent to which genomics can inform efforts at health behavior change is warranted. In this commentary, we explore three relatively novel possible routes to the integration of genomics and health behavior: (1) genomics may influence health behavior indirectly through intermediate phenotypes, requiring well-defined theory-based and mechanistic models of health behavior, (2) genomics may moderate response to interventions to change health behavior, and (3) genomics, specifically epigenetic variation, may be influenced by health behavior. The integration of genomics into research on interventions to change health behavior is not without challenges and will certainly require transdisciplinary collaborative science to succeed. We provide specific action points for moving the science forward to explore the extent to which genomic information can be harnessed to ultimately decrease morbidity and mortality associated with unhealthy behavior.

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“…The public health benefits of physical activity (PA) across age and demographic groups are well documented [1][2][3][4][5][6]. Yet, only a minority of American adults meets the recommendations for PA [7].…”

Section: Introductionmentioning

confidence: 99%