public health

A Lot of Americans Eat Fast Food. Do You Know What That Means?

By M2|2018-10-09T14:06:16+00:00October 5th, 2018|Public Health, Uncategorized|

A Lot of Americans Eat Fast Food. Do You Know What That Means?

I eat fast food and I don’t mind saying so. My favorite is a Big Mac meal at McDonald’s and I have the blanket to prove it. I also eat my fair share of hot fudge sundaes at Dairy Queen.

Although it isn’t clear which fast food outlets are people’s favorites, a recent study shows a lot of people eat fast food, but maybe not the people you might have thought.

As part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of about 5,000 people were asked what they ate in the 24 hours before the survey. As reported this week in the data brief, Fast Food Consumption Among Adults in the United States, 2013–2016, about 37% of people over the age of 20 ate fast food in the previous day. Younger people were more likely than older people to have enjoyed fast food, men typically eat their fast food at lunch time, and women evidently are more likely than men to have fast food as a snack (probably hot fudge sundaes at McDonald’s or Dairy Queen!). As the chart below shows, at dinner time, fast food is equally popular with men and women.

These survey results were a popular news item, so you probably saw the information somewhere already. But a few points stood out to me about the importance of updating information we may have learned in the past, either because new data has become available, or simply because we haven’t yet had an occasion to refresh our knowledge. If you haven’t read it, Factfulness: Ten Reasons We’re Wrong About the World–and Why Things Are Better Than You Think by Hans Rosling is a great book about various facts we might have learned that need to be updated.

First, as a person trained in public health, I have been taught that people consume more fast food if they have lower incomes, in part because fast food is most affordable and available to them. This data brief indicates the relationship between income and fast food consumption goes the other way. That is, people with higher incomes ate fast food more frequently than people with lower incomes as shown in the chart below.

Yes, you could calculate “fast food consumption” in different ways, and perhaps the quantity of calories consumed as fast food is higher for people with lower incomes, but an idea I had in my head about who eats fast food needs to be updated. Maybe an idea in your head needs to be updated too.

Second, I also know as a person trained in public health, that most people, even those who eat fast food, also eat other things, and that the relationship between food, weight, exercise, and metabolic and cardiovascular health is very complicated. Still, a first of its kind study published in 2014 found that, at least for kids, poor dietary habits outside the fast food environment “may be more strongly associated with overweight/obesity than fast food consumption itself.”

Let’s add that information to our brain’s database as well.

The fast food consumption brief created lots of headlines this week. Hopefully we all took the opportunity to read the articles that went with the headlines and update our point-of-view on what the information actually means.

ICYMI: The CVS-Aetna Proposed Merger Could be Public Health Rocket Fuel

By M2|2017-12-07T01:22:04+00:00December 6th, 2017|Health Care Trends, Health Disparities, Insurance, Public Health, Retail Health, Social Determinants of Health, Uncategorized|

ICYMI: The CVS-Aetna Proposed Merger Could be Public Health Rocket Fuel

Sunday, December 3, CVS Health announced it will acquire health insurer Aetna for $69 billion. Lowering the cost of care by enabling a broader range of treatment in retail clinic settings, of which CVS Health has more than 1,100 in 33 states, is one of the obvious rationales of the combination. But what struck me in the comments of the merging companies’ CEOs was how much they sound like public health professors. Social determinants of health? Health as a path to fulfillment? What have they done with the business people? In case you missed it…

Mark Bertolini Really Cares About the Whole Person

Aetna Chairman and CEO Mark T. Bertolini has been talking publicly for quite some time about the importance of thinking about people not as patients, but more holistically. In September, in an interview with Dennis Berman, the Wall Street Journal financial editor, he said, “We believe the only way to truly disrupt the cost of health care … is to go into the homes and meet the social determinants that are now driving as much as 60 percent of life expectancy of Americans.”

What Bertolini has had to say now that the merger is official is straight-up public health speak. On CNBC Monday morning, when explaining the vision of the merger, Bertolini sounded like a philosopher: “Most people,” he explained, “find their health is a barrier to the life they want to live.” Indeed.

Larry Merlo is Fixated on Unmet Need

Larry J. Merlo, President and CEO of CVS Health, reminded anyone who was paying attention something that we in public health have known for a long time, but surprised the CNBC reporters, “You look at chronic disease in this country today, about half of all Americans have at least one of those chronic diseases. It’s accounting for 80% of the health care costs.”

Merlo further explains, “there’s billions of dollars every year on unnecessary and avoidable spending because people are not following…care plans.” Merlo’s solution, to be executed in part with the announced merger, is to address the unmet need the traditional health care system is creating, but CVS Health knows first-hand because patients come through its doors with health care needs that aren’t being met.

We “lack the element of convenience and coordination…that is the unmet need we are talking about,” says Merlo.

We Are All Public Health

As a public health student, educator and professional, I am public health. This merger discussion shows we are all public health. Georges C. Benjamin, M.D. Executive Director, American Public Health Association wrote in 2015, “Today, the biggest threats to the health and longevity of Americans are preventable diseases. These are the diseases that are burying us in preventable suffering, as well as crippling our communities with mountains of avoidable medical bills. The root causes of many of these health threats are inextricably linked to the social determinants of health and the conditions that shape a person’s opportunity to attain good health and adopt healthy behaviors. These social determinants include access to safe housing, good jobs with living wages, quality education, affordable health care, nutritious foods, and safe places to be physically active. They also include racism, discrimination, and bias.”

To see such similar language from Mark Bertolini and Larry Merlo in the CVS-Aetna merger discussion to date shows that the leaders of what could become the largest health care company in the U.S. are thinking differently about the broken U.S. health care system. Near the end of the investor call about the merger, an analyst asked whether the combined entity planned to be a person’s primary care physician. Bertolini answered: “The real important part here is that you have to understand that almost 60% of Americans don’t have a regular doctor.”

When you connect these dots, you can really see the big picture come together. The CVS-AET vision is bigger than managing the pharmacy benefit.

Will it work? Hard to say at this early stage. Should consumers want it to work? Absolutely. A health care company with a public health lens that focuses on health well before a person shows up at the doctor and prioritizes convenience, coordination, and social determinants of health would be a welcome change for individuals, families, and employers. Score one for public health.