Although I'm sure everyone agrees that health is multifaceted, not all will agree that changing the current health care system will maximize everyone's potential for living. Some posited in class that access to health care is not the end-all to bringinf out that potential for living in each individual. Individuals' lives are affected by more than a doctor's visit.

In the prompt, a couple of examples for change are given which i find interesting. Measuring happiness could determine a patient's potential for living but ultimately how does one take information like "you're happy in life" or "you're not happy in life" and "fix it" so that your potential for living increases? With a diagnosis for high blood pressure, people can pop a pill or two and fix it, but not the same with increasing potential for living. If we have nurses gather more information (or "indicators") like happiness as a way to change the current health system, I would imagine more would need to be done than just measurements to better one's potential. But that somewhat leads into the second example of having doctors helping to build up social networks. Research has shown that social networks can have a positive effect on how one deals with the stressors of life, which to me translates to having positive effect on a person's state of health and potential for living. According to Breslow's article, doctors are seen as professionals who help prevent and overcome disease, but doctors are overwhelmed when trying to fulfill his/her duty through the current system. What kind of role would a doctor play in helping to build social networks? If a person is deemed unhappy on the happiness scale, does his/her doctor play matchmaker? At what point can the doctor stop overseeing his/her patient's well-being? On a different note, even in the current system doctors already help some patients build up social networks when they refer them to support groups for cancer, grieving, disability, etc. Why (and how) should this system change if, to me, this falls under the duties of his/her profession, but going beyond that seems more like what a friend would do and less like a doctor?

I think that recognizing the implications of mental and social aspects of health - especially that they are separate from and equally important as physical health - is progress. As described in the article, traditional views have focused on disease, both communicable and chronic. Since the third era of health implies achieving the maximum potential for living, I agree that the improvements in the health care system will require collaboration on the part of physicians and public health professionals in traditional settings, as well as teachers and counselors in school and workplace settings. These three aspects of health rely upon one another, which I think makes our efforts to define "health" so difficult; if health is dependent upon what we eat, how many friends we have, how safe our neighborhood is - just to name a few - then health permeates every aspects of our daily lives, and it's unreasonable to expect that health improvements will arise simply through a restructuring of the current health care system. While restructuring certainly is essential, I think that health-related expansions need to occur in sectors such as education, business, and urban planning and development. These efforts should be preventive in nature, with an emphasis on mental and social health - providing social support systems to schoolchildren and employees, and city development in which the focus lies on the improvement of people's well-being, rather than on budget restraints.

Health measurements will change as a result of such a collaborative effort. As others have mentioned, the development of valid scales for mental and social well-being will aid our efforts to improve these aspects of health. Screenings for depression and other mental illnesses exist, but these tend to vary more than measurements for blood pressure and blood glucose levels, which have been standardized. I think a greater emphasis on mental and social health will significantly improve measurements in these two aspects.

On another note, now that Scott Brown has won Ted Kennedy's Senate seat, I think Obama's plans for health care reform are about to hit a major roadblock.

week 2

Having nurses measure happiness at each check-up is simply not practical because of its obvious subjective nature.

If the first and second eras of health are communicable disease and chronic disease, according to the article, maybe the third era can focus on wellness, aimed towards maintaining health before getting to a disease state. For example, Metabolic Syndrome is not a disease in itself, but a list of conditions an individual has (increased waistline, high blood glucose, high blood pressure, etc), that are associated with increased risk of more serious degenerative diseases, such as cardiovascular disease. If we approached measurement of health in this manner, we could have a list of healthy habits that individuals participate in, i.e. exercise, consuming a variety of food groups each day, not smoking, etc. For each additional healthy habit, the individual could be rated as having X% reduced risk for various diseases associated with different lifestyle habits. Also, if a patient is otherwise healthy according to current standards but does not practice any number of these healthy habits, maybe the doctor could refer them to specialists in nutrition, exercise, or other wellness-associated activity, similarly to how doctors can refer patients to other specialized doctors.

It seems as though measuring the social aspect of health is easier than measure mental or emotional health - we could look at the number of friends someone has, or the number of times per week that a person hangs out with someone other than family for more than 30 minutes. If we were to measure mental and emotional states, we'd first have to develop some kind of scale that's valid and accepted. For instance when I worked at the Cedars-Sinai medical center, I'd always witness doctors asking patients what their pain level is according to the "pain scale" - a chart of facial expressions depicting what someone might look like when he/she is experiencing various levels of pain. We might have to develop some kind of tool analogous to the pain scale to measure mental and emotional health.