The Implication Of Personal Decisions On Health

I was reading Ralph Keeney’s article “Personal Decisions Are the Leading Cause of Death” over the weekend. It’s very interesting. He attributes 1M of the 2.4M deaths in 2000 in the US to personal decisions that we make. And, unfortunately, he says that retrospective analysis would suggest we’re on a bad trend line of increasingly being responsible for a greater percentage of our deaths.

The article points out that the fact that these are personal decisions makes this a manageable issue.

1. We can engage consumers to take more responsibility for their healthcare.
2. Improving decision making is less expensive and in some cases more effective than other options.

“A personal decision is a situation where an individual can make a choice between two or more alternatives.”

“A premature death resulting from a personal decision is defined to be one where an individual dies sooner than would have been the case if a different choice had been made.”

The premature deaths attributed to personal decisions in the article are:

• Smoking
• Weight
• Alcoholic diseases
• Accidents
• Suicide
• Unprotected sex
• Homicide
• Illicit drugs

If you go read the paper, you can see how he breaks down each of these areas.

What I also found very interesting was the breakdown of the percentage of deaths by age group that are attributable to personal decisions. [I honestly expected it to peak earlier, but I think the fact that 80% of the impact is from smoking and weight that it takes time to see that impact.]

“Take control of your own health. Studies show that at least two-thirds of cancer deaths can be prevented by not using tobacco products, maintaining a healthy weight, getting plenty of physical activity, eating health foods, and avoiding the midday sun and protecting the skin with a hat, shirt, and sunscreen.” (Quote from the American Cancer Association)

A key question is whether people feel responsible for their own health. A 2009 survey by Thomson Reuters showed that those with a higher education level had a much stronger sense of that ownership (71.2% for those with a college degree versus 47.5% for those with less than a high school education).

The article made me think of a few things:

• Why you should go get a check-up (from Men’s Health)
• My interview with Dr. Wennberg on Shared Decision Making
• My interview with Dr. Strecher from HealthMedia

Much like Silverlink Communications, many healthcare companies are very focused on consumer engagement. As this article points out, getting consumers to understand the impact of their decisions on their health may be a very effective way of reducing premature deaths. That should also reduce the burden of chronic conditions on our economy.

“Seven chronic diseases…have a total impact on the economy of $1.3 trillion annually. Of this amount, $1.1 trillion represents the cost of lost productivity.” (Milken Institute)

While we typically focus on throwing money or incentives at the issue, this may not always be the answer (see post on the book – Drive). There are many simple interventions to help address health literacy and help consumers understand the need to take action (see post on cured after the first fill). Creating personalized communications that address people’s barriers is a critical success factor for healthcare organizations. There are several critical success factors to consider:

• Help consumers understand the need for the action (WIIFM)
• Make it simple so they can fit it into their busy schedules
• Coordinate with the physician
• Address their fears
• AND, be cognizant of cost and the burdens this can cause (see recent article on OOP spend for people with cancer)