Healthy Living

Mom and Dad? We Need to Talk.

While watching our parents grow older is tough, the hardest part of it for most of us is the role reversal that takes place.  Suddenly sons and daughters are taking care of moms and dads — and that can often start with tough conversations on awkward subjects.  How do you talk with Mom about when it’s time to stop driving?  When Dad re-enters the dating world, what’s the best way to broach the topic of safe sex?  This episode of Total Health Radio is all about these difficult — but necessary — conversations we need to have with our aging parents.

Connecting Health With Place

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Editor’s Note:  We often write pieces on the Center for Total Health blog about how important our surroundings can be to our health.  We’ve covered passionate discussions around built environments, and we’ve highlighted success stories.  What we haven’t been able to capture so far is the process.  We have invited Scott Kratz, director of 11th Street Bridge Park – a newly launched project – to share with us some of his experiences as he takes this vision of a shared community space that supports health from concept to reality.  This is his first post with us.

Can your zip code determine your health? Epidemiologists tell us that place – where we live and work – is one of the greatest factors in health outcomes. Urban planning decisions afect people’s health. We know there is a strong link between regular physical activity and lowered risk of obesity and chronic diseases. But what if there is no safe place to play? What if one’s home is located in a food desert, as it has been for many residents in Washington, DC, without access to healthy meal choices?

Linking place and health is a key goal of the 11th Street Bridge Park – an innovative project in the nation’s capital to transform an old freeway bridge into a new civic space. As the 11th Street bridges across the Anacostia River have reached the end of their lifespan, the DC Office of Planning and a local non-profit, Building Bridges Across the River, will use part of the remaining infrastructure to build the 11th Street Bridge Park, a new park above the river.

We have led an extensive public outreach campaign asking local residents for their programming suggestions and have received many inspired ideas and wonderful support. The community has suggested innovative play spaces, urban agriculture, an environmental education center and kayak / canoe launches on the river below.

Community outreach continues with a brainstorming session on Tuesday, March 25 at Kaiser Permanente’s Center for Total Health with presentations by 11th Street Bridge Park’s team. All of these ideas will inform a nationwide design competition launched in March to imagine the new park.

But we need to be more than aspirational. We need results. To understand the ways that access to green space, farmers markets, planting festivals and kayak launches may improve health outcomes, we are implementing a Health Impact Assessment. This baseline data of residential health will enable a comparative analysis after the 11th Street Bridge Park opens in 2017/2018. If we’re successful, we can make a solid link between health and place — and build a bridge to a healthier Washington, DC.

A Healthy Beginning for Babies and Their Moms

CEX12d041Last week’s annual “Building a Healthier Future” Summit put on by the Partnership for a Healthier America provided an opportunity to highlight what many organizations across the country are doing to address the underlying causes of childhood obesity.

For Kaiser Permanente, that meant not only a chance to show that we could and did deliver on our commitment to the highest levels of exclusive breastfeeding within our hospitals, but also the opportunity to showcase how Kaiser Permanente is building upon those successes by rolling out a comprehensive “Healthy Beginnings” effort to address the health of mother and child throughout the first years of life.

Robert Riewerts, MD, regional chief of pediatrics for Southern California Permanente Medical Group and clinical lead for childhood obesity for Kaiser Permanente presented an overview of the Healthy Beginnings work at a breakout session at the Summit. We had the opportunity to interview Dr. Riewerts alongside Jocelyn Audelo, RN, senior consultant at Kaiser Permanente’s Care Management Institute who coordinates Kaiser Permanente’s interregional work around Healthy Beginnings.

CTH Blog: Why is Kaiser Permanente focused on supporting a program of “Healthy Beginnings?”

Dr. Robert Riewerts: As an integrated health care system, Kaiser Permanente has been very interested in providing the best support we can to breastfeeding mothers. In our system, we deliver nearly 90,000 babies each year, so we have an incredible opportunity to make an impact on the lives of those babies.

Childhood obesity is a serious problem in America, and we’ve learned from research and from the care of our own patients, that if we support breastfeeding effectively, we’re going to produce a population of children that start out healthy. With effective breastfeeding support, those babies will get the important nutrients they need as young babies and they’ll be more likely to be healthy children later on.

Jocelyn Audelo, RN: Pregnancy is also a critical time in the development of healthy habits. As a new family is coming into being, we have the opportunity as a health care system to help support some of the habits – like breastfeeding, healthy diet patterns, and plenty of movement – that can translate to a pattern of well being over time for a family.

CTH: What can you tell us about the recent research showing trends in obesity reduction in children age 2 – 5?

RR: There’s been a lot of excitement around the recent article in the in the Journal of the American Medical Association that showed a 43% reduction in obesity in early childhood, ages 2 – 5, range. This research gives us hope that the work that we’re doing is effectively reducing the rate of childhood obesity. One of the factors quoted in the article is the fact that early breastfeeding and the support of breastfeeding may be an effective reason why we are seeing this reduction in obesity.

Although we are hopeful that this is a trend for the future, we still have a whole lot of work to do. And Kaiser Permanente’s relationship with the Partnership for a Healthier America and our commitment to the Partnership represents a road that we will be staying the course on, in order to make greater progress in addressing childhood obesity.

CTH: What would a comprehensive Healthy Beginnings program look like?

JA: At Kaiser Permanente, we feel that there is an opportunity to broaden our approach beyond just breastfeeding in support of a healthy weight trajectory throughout life, that really has its beginning in the pregnancy and early childhood time frame. Healthy Beginnings is our Kaiser Permanente approach to support healthy weight, active living and good nutrition from the time before a woman becomes pregnant, throughout her pregnancy and throughout the early life of the child. Examples might include things like helping women to get healthy and fit before conceiving, supporting women and families in emotional and behavioral health, helping pregnant women to stop using tobacco and other harmful substances, and teaching how families can incorporate a pattern of healthy foods – with plenty of vegetables and fruits – for babies and young children.

RR: Kaiser Permanente has a wealth of employees involved in all sectors of health care. We want all of our physicians, our nursing staff, our doctors who are delivering babies and caring for mothers during pregnancy to be aware of the importance of breastfeeding and to really start that infant out on a good healthy lifestyle.

JA: We know there are lots of things that we can do clinically to support a healthy beginning, but we know it needs to be much bigger than that. It needs to involve our community partners, our built environment to support physical activity and good nutrition, and numerous areas that we need to continually develop capacity in.

Since we know that what happens during pregnancy and the early childhood timeframe is critically important for a life course of Total Health, we’re focusing intensely on this Healthy Beginnings work. We are very excited about the journey we’re on, to support women and children and their families on a trajectory of Total Health from the beginning.

The NO MORE Campaign Celebrates its First Year with More Support Than Ever

This week, the NO MORE campaign against domestic violence and sexual assault is celebrating its first anniversary.  The public awareness campaign has focused its efforts over its inaugural year on gaining support with Americans nationwide, sparking new conversations about these problems and moving this cause higher on the public agenda.

While domestic violence and sexual assault are historically two issues that corporations have shied away from addressing, this week, many major corporations pledged millions of dollars in new commitments.   You can read more about how these private sector organizations are showing their support in the official press release.

Earlier this week, advocacy groups and corporate leaders – including Jack Cochran, MD, executive director of The Permanente Federation, on behalf of Kaiser Permanente – met with White House officials, including representatives from the White House Council on Women and Girls, to discuss the important role that all stakeholders – including the private sector – can play in supporting domestic violence and sexual assault programs.

To learn more about how to support the work of local domestic violence and sexual assault prevention organizations or to participate in, “NO MORE Week” visit  You can check out the campaign on Facebook, or you can join the conversation on Twitter by following the hash tag #NOMOREweek.

Herbs, Hypnosis, Chiropractic…Oh My! All About Alternative Therapies

Complementary and Alternative Medicine — which can include anything from massage therapy to acupuncture — is the topic of this week’s episode of Total Health Radio. Harley Goldberg, DO, with Kaiser Permanente Northern California, walks us through the ins and outs of approaches to health and wellness that are not typically part of western medicine but are being used more and more as complementary therapies. Find out how pain can be managed with alternative medicine and why it’s so important to talk with your personal physician before starting any sort of herbal supplements. Listen!

Random Acts of Total Health

Every year, thousands celebrate Mardi Gras on the streets and in the bars of New Orleans. The next day, Ash Wednesday, marks the beginning of Lent for Christians around the world.

In my childhood, these two days were a little confusing – I get cake and parades on Tuesday, and then have to fast and go to mass on Wednesday? Lent always meant giving something up, as if punishing ourselves. That doesn’t make any sense when you’re six years old. As an adult, it seems to fit much better – a day of indulgence followed by a day (or several) of recovery, with time to reflect.

As an adult, my Lenten sacrifices aren’t actually sacrifices at all. Instead, I  aim to improve myself and my community through conscious, deliberate (but often small) changes. And, thanks to Catholic guilt, I take Lenten resolutions far more seriously than those made at the start of a new year or any other time. For the next six weeks, I will do at least one good deed each day. This morning, for instance, I helped an elderly man onto the bus over a snow bank. It’s small, but it seemed to make his day. And, in turn, maybe he’ll make someone else’s.

As for improving myself, I’m focusing on my diet and aiming to eat the recommended two cups per day of fruit and veggies.

It’s not much, but it’s what I can do to improve my total health.

Conflict Resolution in Kids – This Week on Total Health Radio

In a time when bullying has risen to even greater heights, whether on the playground or online, it’s worth asking the question: How can we best equip our children with the skills and behaviors they need to resolve conflicts on their own?

This week’s Total Health Radio features a conversation with Anabel Castrezana, a marriage and family therapist from Kaiser Permanente Southern California, who shares with us ways we can model empathy and healthy expressions of emotion for our toddlers and kids. Have a listen.

Connected Care is Better Care

Dr. Robert Pearl, CEO of The Permanente Medical Group (Photo courtesy Health Affairs)

Dr. Robert Pearl, CEO of The Permanente Medical Group, speaks at Health Affairs briefing on Feb. 4. (Photo courtesy Health Affairs)

“Connected care” is gaining more momentum in the health care industry.  Health care providers are adopting electronic health records with federal support and standard setting. Consumer electronics makers and applications developers are offering more tools and devices for consumers to track and manage their health.  Patients have more options for accessing care and information, and communicating with care teams.

On February 4 in Washington, DC, Dr. Robert Pearl, CEO of The Permanente Medical Group, shared Kaiser Permanente’s experience as a leader bringing electronic tools to its 3.4 million Northern California members in a discussion sponsored by the journal Health Affairs.   Here is Dr. Pearl’s article in the recent issue and a video recording of the event and slides.

Dr. Pearl shared his optimism that health care is poised to be transformed by electronic technology in ways similar to the retail, travel, and finance sectors. He also noted some barriers in the way, including a predominantly “fee-for-service” payment model that fails to incentivize non face-to-face care or investments in information systems geared to prevention and care coordination. “We can’t just lay technology on the current system,” Dr. Pearl noted. He cited new payment models such as ACOs, the growing popularity of Medicare Advantage and its “5 Stars” quality incentives, and hospital readmission penalties as all providing momentum for changing behavior of physicians and other parts of the health care system. Read More

Total Health Inspiration: Sochi 2014

sochi-2014-logoAt the Center for Total Health, we spend a fair amount of time discussing what total health is, exactly. We all enjoy hearing new definitions from our guests, which are inevitably interesting and different from what we’ve heard before. One thread that appears often is that these definitions tend to be positive and aspirational.

On Friday, people around the world will gather to watch the Opening Ceremonies for the 2014 Winter Games in Sochi, Russia. Few things are as inspirational and aspirational as the Olympics, and I, for one, cannot imagine a better picture of health. Of course these athletes are in top physical health, most having trained since childhood to earn a spot on their country’s team. But more than that, this is a group of people who are, right in front of us, achieving a life dream. Imagine the mental, spiritual, and emotional charge that comes with that. Most of these people won’t win gold, or a medal at all, but they have made it to the best of the best in their sport. They have earned this spot. And they get to compete.

Sounds like total health to me.

You can find the full schedule of Sochi events here, and meet Team USA hereThe Atlantic has a fantastic piece on how Olympians stay motivated — with advice we can all apply in our daily lives — that you can read here.  And for some amazing inspiration, check out individual athlete stories here.

How’s Your Heart? Understanding Your Risk

February is Heart Health Month – a great time to think about your heart and the hearts of the women you care about.  This episode of Total Health Radio is about women’s heart health – and in it, we talk about how heart attack symptoms differ between men and women.  Check it out.

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