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NEWS FOR YOUR WELL-BEING Health Literacy U. S. Surgeon General Richard H. Carmona, MD What do a pregnant high-school dropout, a college-educated computer scientist managing a post-surgery wound, and an elderly married couple who must take several different medications have in common? Answer: They’re all vulnerable to misunderstanding instructions about medications, diet and physical activity, and other health-related information. These vulnerabilities could cost them their health and even their lives. Low health literacy, or the inability to understand, access, and use healthrelated information and services, is an equal-opportunity health threat, affecting rich and poor, young and old, and people of all racial and ethnic backgrounds.

Low Literacy, High Cost Health literacy is fundamental to the success of every prescription, every treatment, and every recovery. It’s also fundamental to making smart choices like quitting smoking or never starting, wearing your seatbelt and buckling up the kids, and getting the preventive health screenings you need. Patients with limited health literacy have poorer health habits, are less likely to get preventive screenings, and are more likely to need hospitalization. More than 90 million Americans cannot adequately understand basic health information. A study of English-speaking patients in public hospitals revealed that one-third were unable to read basic health materials. Twenty-six percent of the patients could not read their appointment slips, and 42 percent did not understand the labels on their prescription bottles.

Low health literacy adds as much as $58 billion to America’s healthcare costs each year, with employers absorbing much of the burden through higher insurance premiums and lost productivity. Importantly, basic health literacy is critical as we seek to prevent chronic health conditions and diseases whose origins are in smoking, drinking, unhealthy eating habits, and physical inactivity. What’s called for is improved health education from elementary school through college, increased focus on health literacy in medical schools, and more creative public health information campaigns. The U.S. Department of Health and Human Services (HHS) is taking steps to improve American’s health literacy, including: Surgeon General communications written in plain language that people can understand; a new education and outreach campaign to better inform Americans about when antibiotic treatment is needed and about the potential dangers of taking antibiotics when they’re not needed; and new low-literacy publications aimed at helping people avoid medical errors, take medications safely, and obtain appropriate preventive services. For its part, the U.S. Food and Drug Administration is requiring that manufacturers of most conventional foods and some dietary supplements list the content of trans fat, a known disease agent, in addition to the information that is already in the Nutritional Facts panel of most foods.

Bottom Line Benefit Business has an important role, too. Employers can take the lead in promoting

healthy habits among their employees. Employer-sponsored wellness programs, both on and off the worksite, are a good investment, for employer and employee. Innovative workplace health promotion activities can include weight management, smoking cessation, exercise programs or facilities, immunizations, and substance abuse counseling. Businesses can also take their efforts beyond educating and informing employees by connecting their employees to healthcare services. For example, don’t stop at helping employees understand why a flu vaccine is important but make sure they know where and when they can get one. As Surgeon General, I’m asking healthcare professionals to focus on their patient communication skills. Similarly, business can use plain language to communicate clearly with consumers and employees. Improved health literacy can save lives and improve the health and wellbeing of millions of Americans. Over time it will improve the bottom line for our nation’s businesses and make for a better relationship between employers and employees. That’s a win-win.

Conceived and produced by New Futures Media Inc., Health Horizons provide information from leading medical experts that contributes to the health and well-being of our readers and their families. New Futures Media also creates special advertising features that raise public awareness of other important social issues. The information and opinions expressed in this special section do not constitute endorsement of advertisers or their products by New Futures Media or the contributing authors. For information about our company and our work see www.NewFuturesMedia.com or contact us at info@NewFuturesMedia.com.

REPRINTED FROM A SPECIAL ADVERTISING SECTION APPEARING IN THE JUNE 21, 2004 ISSUE OF

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John H. Klippel, MD Arthritis is the nation’s leading cause of disability and a major public health concern. It has a profound impact on people’s daily lives, affecting their ability to work and care for themselves and their families. The economic costs of arthritis exceed $86 billion annually. The problem for American’s—and for the nation’s healthcare bill—will worsen over the next several decades as an overweight, inactive, and aging population contributes to a marked increase in osteoarthritis—the most common form of arthritis—which currently affects nearly 21 million Americans.

What is It? Osteoarthritis (OA) is characterized by the loss of joint cartilage— the surface of the joint that cushions the ends of bones— as well as changes in the bone itself. This leads to pain, stiffness, and loss of joint movement. People with OA may notice joint stiffness when they first get up in the morning or after prolonged exercise, a limp when walking, or pain and redness in the fingers. OA can range from very mild to very severe. It most commonly affects hands and weight-bearing joints such as knees, hips, feet and the low back and neck. There is intense research to learn more about the causes of OA, but a number of risk factors have been identified. Age is one important risk factor.

Obesity is associated with OA of the knees and joint injuries from sports, work-related activities or accidents also increase the risk of developing OA. Genetics plays a role, too, in the development of OA, particularly in the hands. Osteoarthritis is more common in women, and there is some evidence that hormonal factors may contribute to the disease.

What Are the Risk Factors? Age OA usually affects people after age 40. Gender Women are more than three times as likely as men to get OA. Weight Being overweight increases the risk of knee OA.

Diagnosis and Treatment Options Physicians rely on a careful history and physical examination to diagnose OA and distinguish it from the more than 100 different forms of arthritis. X-rays may be used to detect cartilage or bone changes and to confirm a diagnosis. The most common symptoms of OA include pain, stiffness, swelling, and difficulty moving a joint. The treatment of osteoarthritis focuses on the goals of decreasing pain, improving joint movement and function and preventing progressive joint damage, and may include: ■ Exercises to improve muscle strength and keep joints flexible ■ Weight control to prevent extra stress on weight-bearing joints such as the knees, hips, and low back ■ Medications to control pain, including analgesics such as acetaminophen and non-steroidal antiinflammatory drugs (NSAIDs) ■ Joint injections with corticosteroids or viscosupplements ■ Topical ointments or creams ■ Local heat or cold applications ■ Dietary supplements such as glucosamine and chondroitin ■ Joint protection to prevent strain or stress on painful joints ■ Surgery to relieve pain and restore joint function

Can it be Prevented? Osteoarthritis was once considered an inevitable part of aging. People thought if you lived long enough, you’d eventually get OA. Now, however medical

Sports Injury Adolescents and young adults with joint injuries are at higher risk. Heredity Men and women with a family history of arthritis are at higher risk.

researchers are learning more about how the disease develops and possible ways to control risk factors for OA. By being aware of what may put you at risk for the disease, you can reduce your risk of developing the disease or minimize its effects. To prevent the development of OA, the Arthritis Foundation recommends the following: ■ Control Weight — Maintaining an appropriate weight or reducing weight to a recommended level lowers a person’s risk of OA. Research shows that weight loss of only 11 pounds in women of medium height decreases the risk of developing knee OA by 50 percent. ■ Get Active — Regular physical activity helps improve and maintain, muscle strength and joint flexibility. ■ Prevent Sports Injuries —Young and middle age adults should take preventive measures to minimize joint injuries, which puts them at considerably increased risk for OA later in life. ■ Modify Job Tasks — Repeated use of joints in jobs that require bending and lifting is associated with an increased risk of developing OA. John H. Klippel, MD, is president and CEO of the Arthritis Foundation. For free information about taking control of OA, contact the Arthritis Foundation at 800-283-7800 or www.arthritis.org.

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Understanding Osteoarthritis

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Disease Management: Controlling Costs, Improving Care Victor Villagra, MD One of the most pressing concerns facing U.S. businesses today is the rising cost of employee health insurance. Chronic diseases, in particular, take a very high toll on medical costs and also on employee productivity. For employers interested in improving the quality of care, raising productivity, and controlling healthcare costs, “disease management” is becoming the strategy of choice. Through disease management programs, people with asthma, diabetes, congestive heart failure and other chronic diseases are provided with the information, motivation, ongoing support and tools they need to help them with self-care. Disease management programs work remarkably well cutting cost and have received rave reviews from participants.

Proactive, Not Reactive Typically, patients involved in disease management programs become more proactive and are more motivated to follow doctor’s orders because they understand better what is happening to them. Using a variety of modern communication tools, disease management programs reach patients when and where it is most convenient to them. For example, disease management take advantage of Internet technology to provides patients with the latest treatment and prevention information, and enables them to interact directly, quickly, often in “real-time,” with trained nurses called care managers or “health coaches”. DM staff maintain regular contact with patients via telephone, mail, remote monitoring devices, and the Internet. For patients, these multi-media approaches to communication means that they can get the

Web Directory www.Aetna.com www.PfizerHealthSolutions.com www.Stryker.com

help they need remotely, without worrying about transportation or having to take time off from work. For employers, this can mean real cost-savings by avoiding costly hospitalizations or emergency room visits and greater productivity from employees who stay at work.

send information to or ask questions of their health coaches, who can quickly respond to new concerns or questions. Not surprisingly, early results show improvements in clinical and financial outcomes. Another large health insurer, Aetna, uses sophisticated analytic tools to identify members who can benefit from

Driven by Information Currently, the short time spent in physicians’ offices is devoted to making important treatment decisions. Following a visit to the doctor, patients often have additional questions and require support to put into practice their doctor’s recommended treatment and behavior changes. Disease management programs never initiate new treatments or alter existing therapies but support patients in adhering to prescribed treatments. Learning about their conditions and the reasons behind their treatments gives people great confidence in helping themselves make the right decisions about lifestyles and adherence to their doctor’s treatment plans.

Already a Reality One example of how disease management is helping employers is a Corporate Disease Management program implemented by WellPoint Health Networks, one of the nation’s largest health insurers. WellPoint collaborated with Pfizer Health Solutions and two large corporations to provide selected employees with access to a novel cardiovascular disease program that empowers patients to take a more active role in their health and address gaps in their usual care. With the assistance of a nurse “health coach”, participants monitor their cholesterol level, weight, blood pressure, diet, activity levels, efforts to quit smoking and other critical components of cardiac disease prevention through a dedicated, personalized Web page. Patients can

DM programs. The data from members with specific chronic conditions are examined and grouped together, based on the severity of their condition to enable the appropriate DM intervention. Extensive analysis demonstrates improvements in both the quality and cost of care. Aetna determined that a large employer with 10,000 employees and with a demographic mix and benefit design similar to Aetna’s typical corporate client could save a projected $224,000 annually in direct medical costs, reduced absenteeism, and short-term disability savings. As a result of these disease management programs, healthcare consumers are now able to reduce risky healthrelated behaviors and live healthier lives. This means healthier, happier, more productive employees and a healthier bottom line for companies adopting these programs. Victor Villagra, MD is president of the healthcare consultancy Health and Technology Vector Inc. and former president of the Disease Management Association of America. For information on BusinessWeek Special Advertising Sections contact Stacy Sass McAnulty at 212 512-6296 or stacy_sass-mcanulty@businessweek.com.

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