| Subject: Re: an ownership society_v1.3.2 |
Author:
pjk
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Date Posted: 02/ 9/05 9:37:13pm
In reply to:
krz
's message, "Re: an ownership society_v1.3.1" on 02/ 9/05 11:01:56am
thanks for the response krz
>If we can establish a clear relationship between a
>behavior and health then perhaps we can start to shape
>policy to add accountability. This way we deal with
>the issue of body mass index (as an example - perhaps
>not the best measure) as opposed to a behavior. E.g.,
>bmi needs to be within 3 points of normal for age - if
>you exceed you change the behavior (eat less/exercise
>more/eat differently) to get yourself there.
I was thinking about this on my walk to & fro the playground with Jack and zimm and, as usual, confronted how little I actually know about (fill in the blank) the causes of obesity or research on the health consequences of bmi over 3 points of normal... mk's mom is pretty over weight and has been making strides to lose it. She was not always so... she was quite active in her younger years playing tennis and golf, but then somewhere along the way things went south... it got me thinking about the psychological aspects of obesity... compensating loss, a hole in the heart, childhood abuse, what have you... the endless list of reasons as to why people are to varying degrees self-destructive. The relationship between behavior and pyschological make up... and then that relationship to health. I was also curious as to what the effect on culture & identiy might be if certain foods or amounts were verbotten. I'm curious how the psychological & cultural aspects might fit into your scheme.
One always hears the word "genetics" mentioned and I've also come across articles written by "overweight" people that deny obesity per se is the problem, rather the quality of food and exercise what we have to account for... and that other behaviors are just as or more detrimental and that it is prejudicial to single out fat people.
I've always been a label reader (instilled through reading cereal boxes - they should pring novels on them in sections!) but shopping for jack makes me all the more aware. Take corn syrup for example... its presence seems ubiquitous. It leads me to wonder to what degree does poverty or low income figure in to poor diet and obesity? And what sort of opportunities are available to mothers and fathers or whoever else slaving away at $5.65 and holding 1 or 2 or 3 jobs for better food and time for exercise? What role do (more readily available) cheap sugary fatty salty processed foods play in America's love affair with being bigg?
Getting back to the smoking... I heard a report on how smoking has been banned in NYC and that business has not suffered at all (if anything it has gotten better) and that even smokers are glad to smoke outdoors b/c it saves them money on dry cleaning and also gives them an opportunity to meet people. I think this is a case where a person's right to breath clean air trumps a person's right to smoke where they please. I think the same could be said about eating well and exercising... it improves health and pyschology... it's a no brainer, really, so I'm sympathetic to your point of view, especially with your professional experience.
>In practice in CA, I would often link receipt of
>therapy services (from me) to those factors that would
>also modify the behavior that landed the client to me
>in the first place. Most common - requiring
>concurrent participation in drug/alcohol programs in
>order to receive therapy. The interesting
>reimbursement model we were working under though was
>outcome driven. The insurer never paid for an hour of
>my time - as is typical - but paid me to get the
>patient to a specific outcome (like return to work, or
>return to being primary caregiver). That way, I could
>demand participation in those things that could affect
>my ability to achieve an outcome but that I'm not
>qualified nor ready to add to my treatment strategy.
>I loved the system- most providers are wary.
This is interesting... were there times you were not paid b/c the desired outcome was not acheived by your patients? And if so, was the fee calculated to compensate for whatever this percentage might have been?
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