Microcirculation plays a crucial role in our overall health, influencing blood flow through the tiniest vessels in our circulatory system. Did you know that by age 20, 40% of microcirculation to the skin is lost? By age 40, this could rise to nearly 80%, leading to compromised microcirculation and inflammation in the body.

Looking to revitalize your microcirculatory system, reduce inflammation, and improve your well-being? Check out Wellness Academy’s USA Urban Lifestyle Wellness Retreats in San Diego and Coconut Grove, Miami. Let’s embrace a holistic approach to wellness and bring our bodies back to homeostasis for a vibrant life!

Nature Got It Right

Wellness Academy USA – San Diego

Miami Health Coach – Coconut Grove, Miami

Biologically Younger’ People Who Defy Their Real Age Often Have 5 Things In Common

Dan Buettner, the man who popularized the idea that there are five “Blue Zones” around the world where people live some of the longest, healthiest, happiest lives, says people living in those zones all share five common traits.

“It is this interconnected web of characteristics that keep people doing the right things for long enough, and avoiding the wrong things,” Buettner said.

Blue Zone residents, whether they’re home in Loma Linda, California; Ikaria, Greece; Okinawa, Japan; Sardinia, Italy; or Nicoya, Costa Rica, all eat very little meat. Instead, they subsist on a largely plant-based diet filled with beans, nuts, and cruciferous vegetables, which Buettner has written about in a new cookbook.

But that diet, which bears some resemblances to a Mediterranean diet (named the best diet for 2020 by US News and World Report) is only about 50% of the Blue Zones longevity equation.

“It’s the scaffolding, this collagen,” Buettner told Insider. “That keeps people eating the right way for long enough.”

Here are the other four core principles that sustain life in the Blue Zones.

Move regularly, about every 20 minutes – Going to the gym is not a Blue Zones tradition.

“They don’t exercise,” Buettner said. Instead, people in Blue Zones are “nudged” into movement in little bursts throughout the day, by force of habit and, also, necessity.

“They’re walking, or they’re in their garden, or they’re doing things by hand,” he said.

In Buettner’s home state of Minnesota, he credits shoveling the walks in winter, digging, weeding, and watering a garden in the summer with keeping him spry.

“I don’t have a garage-door opener — I open it by hand,” he said. “To the extent that I can, I use hand-operated tools.”

He’s turned the inside of his house into a little mini Blue Zone, too, where he’s getting up and moving all year round.

“I put the TV room on the third floor,” Buettner told me, “So every time if I want a snack, I’d go up and down stairs.”

The technique is one he’s honed by studying life in the Blue Zones.

“It’s being mindful of how to engineer little bursts of physical activity,” he said.

Research has shown that such little energetic busts throughout the day can do a lot for overall fitness. One study published last January showed that even 20-second, vigorous stair-climbing exercise “snacks” spread out over the course of a day could improve fitness.

“It’s a reminder to people that small bouts of activity can be effective,” the lead study author Martin Gibala told Insider when his team’s research came out. “They add up over time.”

In Japan they call it “ikigai,” and in Costa Rica it’s a “plan de vida.” The words literally translate to “reason to live,” and “life plan,” respectively, and both concepts help residents of the Blue Zones feel there’s a reason to get up and do what needs to get done each morning.

Studies also suggest that a sense of purpose in life is associated with fewer strokes and less frequent heart attacks among people with
heart disease
, as well as more use of preventive care.

One 2017 investigation from researchers at Harvard concluded that a sense of purpose in life is associated with better “physical function among older adults,” including better grip strength and faster walking.

Good health and happiness can be contagious, and obesity can too.

In Japan’s Blue Zone, people form social groups called “moai” to help them get through life.

“Parents cluster their children in groups of five, and send them through life together,” as Buettner explained in a recent video. “They support each other, and share life’s fortunes and woes.”

The trend is not unique to the Japanese. In Loma Linda, California, Blue Zoners (many of whom are Seventh-day Adventists) are more likely to share vegetarian potluck meals than meet one another over a Chipotle burrito or McDonald’s fries.

Buettner has created Blue Zones “Projects” across the US, where cities and towns enact policies that change the entire environment people live in.

“We’re genetically hardwired to crave sugar, crave fat, crave salt, take rest whenever we can,” Buettner said. “We’ve just engineered this environment where you don’t have to move. You’re constantly cooled down or heated up … and you cannot escape chips and sodas and pizzas and burgers and fries.”

In cities from Minnesota to Texas, he’s helped create healthier communities where policies favor fruits and vegetables over junk food, people form walking groups to move around town and shed pounds together, and many quit smoking, too.

All of this, he said, adds up to troupes of “biologically younger” people, who not only weigh less but suffer fewer health issues as they age.

The Mind Body Relationship, Is A Two Way Street: Mind To Body, And Body to Mind – HealthCoach

HealthCoach “Mens sana in corpore sano” (i.e., “A sound mind in a healthy body”) is possibly one of the phrases in human history with the widest range in meanings. Originally this phrase comes from Satire X of the Roman poet Juvenal (~60–127 AD). Juvenal’s intention with this phrase was rather to teach his fellow Roman citizens the

Food in the Anthropocene: the EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems

People in almost every region of the world could benefit from rebalancing their diets to eat optimal amounts of various foods and nutrients, according to the Global Burden of Disease study tracking trends in consumption of 15 dietary factors from 1990 to 2017 in 195 countries, published in The Lancet. The study estimates that one


The American Diabetes Association (Association) released new research on March 22, 2018 estimating the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined. This figure represents a 26% increase over a five-year period. The study, Economic Costs of Diabetes in the


More than 29 million people in the US have diabetes, a staggering one in four don’t know they suffer from it and K6 children are developing prediabetes at alarming rates.

For those who do, how you regularly track glucose data depends on the type of diabetes one has and the treatment required. Monitoring is commonly done by taking a drop of blood with a pinprick, but a lot of people track continuously with wearables that measure blood sugar at intervals and relay that information to a smartphone or other device. (HealthCoach)

The first option is unpleasant and often inconvenient; the second is costly, and still invasive – but there is hope for diabetics to live more comfortable lives in the future with continuous glucose monitoring.

Non-invasive testing, where the skin isn’t penetrated at all, is the key to glucose monitoring.

Dexcom is one of the biggest names in continuous glucose monitoring with devices used by 200,000 people worldwide. Dexcom’s wearable tracker is made of two parts: a disposable needle that goes just under the skin to monitor interstitial fluid; and a patch that sits on top, housing the electronics that measure the sensor and transmit them to a Bluetooth device.

Most continuous trackers on the market read from this interstitial fluid, as blood glucose diffuses very quickly into it, making it highly indicative of exact levels at any given time. The latest Dexcom device, the G6 is slightly different then the G5.

The G5 and G6 is worn on the upper abdomen and Dexcom boasts that it’s the only one on the market that lets people make treatment decisions from the information. Dexcom states that readings from the device can determine if people should eat carbohydrates or take their insulin which is very unique because competitive devices don’t have that same level of performance.

The G5 is primarily used for patients with Type 1 diabetes, or who intensively manage their diabetes with insulin, but that Dexcom G5 and new G6 is also starting to see some usage by Type 2 sufferers and can be used by a HealthCoach – Gerald J. Joseph

  • 442 million people worldwide have diabetes
  • Sufferers of type 1 diabetes have a lack of insulin production, while in type 2 the body gradually becomes resistant to the insulin it can make
  • According to WHO data, diabetes was the sixth leading cause of death globally in 2015,

Overall- the new G6 improves on many fronts over G5, particularly the outstanding new one-button sensor inserter (applicator), strong accuracy without any finger-stick calibrations (maintaining a short two-hour warmup period), an extension to 10-day wear, a slimmer on-body Bluetooth transmitter, and clearance for use with other diabetes devices under an exciting new FDA pathway.

Compared to the G5, which had 7-day sensor wear, the G6 is expected to be more economical due to the longer 10-day wear

HealthCoach will be using the G6 to gather biometric data (blood sugar) in addition (steps, hydration, sleep, BMI, weight) Gerald J. Joseph says – a continuous tracker like the Dexcom G6 will be able to get better analytics to support people to make chronic disease management decisions in real-time – without the inconvenience of daily blood pricks and to communicate with the doctor – nurse – HealthCoach – “data” in a collaborative process in making lifestyle changes.

Dexcom’s G5 and G6 is currently only FDA approved for abdominal use, but soon smart watches may one day perform the same task?

Continuous Glucose Monitors

Like other CGMs – future watches will penetrate the skin to the interstitial space, but with an interchangeable module which will need to be changed once a month, that sits on the back of the watch and pushes the biochemical sensors under the skin. The accuracy rate is at +/- 8%, however it is yet to get the clearance from health regulators to put it in the hands of consumers.

HealthCoach – People with diabetes incur medical costs about 2.3 times higher than those who don’t suffer from the disease.

Non-Invasive Methods – HealthCoach 

Sweat contains a small amount of glucose which is derived from blood and interstitial fluid -researchers believe thatsweat glands which are distributed throughout the body could reflect dynamic physiological conditions of body which can help in real time a “HealthCoach” champion lifestyle changes “Gerald J. Joseph” says.

Because the correlation of glucose in sweat is much lower than that in the blood, sensitive sensors must become more accurate to match the accuracy of a direct reading of interstitial fluid or blood.

The correlation between sweat and blood glucose also needs to be studied more thoroughly

As for what the future holds – wearable glucose tracking is coming! For Diabetics, there are other factors to consider than just keeping an eye on their blood.

They are at risk for neuropath – open wounds damaging nerves and more prone to foot injuries that don’t heal easily. Early detection is essential and I foresee in the future socks helping the doctor – healthcoach detect increased blood sugar levels.

Our bodies respond to injury with inflammation, which causes heat; socks in the future will alert the wearer with a notification on their smartphone (HealthCoach) when they detect rising temperature in specific areas of the foot.

For proper diabetic foot care, I recommend wearing fresh cotton white socks and replace socks every month to avoid thinning especially with patients who have lost a toe or have had multiple ulcers – in addition to consuming my HealthCoach diet.

Detecting SUGAR

Detecting a massive intake of sugar levels in real time can help you see what sugary foods do to your body in real time – maybe you’ll be less likely to reach for a soda, or even a donut or cookie and just maybe the next time you may choose a delicious whole fruit snack.

More specifically non-invasive continuous glucose monitoring can essentially track your glucose levels just like wearables track your heart rate now. You’d have a daily, minute-by-minute break down throughout your day and no when you’ve been naughty.

You, your doctor and or your HealthCoach could then better and more instantly tweak your diet. And since diet is half of maintaining a healthy lifestyle, it could completely change people’s lives.

There are different levels of glucose monitoring.

Non-invasive continuous glucose monitoring would more likely impact everybody, largely because you’d get that near-instant feedback loop between what you eat and how your glucose is affected.

The level below that is just non-invasive glucose monitoring – this would allow something like a fitness tracker to track your glucose, but not all the time – perhaps at hourly intervals. It would be nice, but it’s not as game-changing as continuous glucose monitoring.

Let’s also not forget that there are around 100 million Americans living with diabetes. Non-invasive glucose monitoring would be a major quality-of-life upgrade, saving them a prick on the finger.

It’s one thing to be able to do non-invasive continuous glucose monitoring, it’s another thing to be able to do it so well it can help advise on insulin dosage for those with diabetes.

Let’s Look Deeper – The Science 

The problem is really about the laws of physics – you simple can not draw that much data from things like interstitial fluid at this time – More on this and how the Gerald J. Joseph – HealthCoach Prevention Program (HCPP) affects blood sugar (HbA1c)- in part II.

It does look like Continuous Non-Invasive Glucose Monitoring seems to actually be working and finally doctors and patients are going see how a can of Coke, grains and or processed foods affects blood sugar.



HealthCoach 2019

You’re committed to becoming more active and healthy. So you join a gym, find a workout buddy, or hire a personal trainer. And like more and more of us, you might also buy a fitness tracker—a wearable wireless device with built-in sensors that measure your physical activity. According to a Gartner study, 68.1 million wearable fitness trackers are expected to sell in 2015, and 91.3 million in 2016.

The North America Fitness Tracker Market is expected to witness market growth 17.2% CAGAR during the forecast period (2017 – 2023).

HealthCoach Data Trackers 

These mostly wrist-worn devices can tell you far more about your physical activity than the humble pedometer ever could. Current trackers—both dedicated devices and smartwatches with sensors—can measure your heart rate, distance traveled, speed, altitude, calories consumed, and even your sleep patterns the night before. As they evolve, and new kinds of sensors are built in, they can do what some targeted, wearable medical devices (such as blood glucose meters and cardiac monitors) can already do: Things like checking your breathing rate, stress level, and different types of brain activity.

But does the average user know what to do with—or even want—all this information? Does the average person really want to become the quantified self, continually measuring, examining, and evaluating their own physical data? Perhaps not: A study by tech consultants Endeavour Partners found more than half of US consumers who have owned an activity tracker no longer use it.

The Science

Dr. Steven Steinhubl, director of digital medicine and cardiologist at Scripps Translational Science Institute, has an idea of why this might be.

“For all of these devices, there has to be this back-end that gives you the useful kind of information that they want from that device,” he said. “There’s that rare ‘quantified self’ who really wants to look at all of the data in a new way and understand. But there’s going to be a much larger percentage of individuals who, the more their activity tracker bothers them, the less they’re going to want to wear it. We have to be able to provide those people with actionable, useful information, only when they need that information, and not just arbitrarily.”

Therein lies the challenge. Developers are taking it on, working on products that translate physical data into personalized feedback that can help users become more active. In addition to popular existing apps like My Fitness Pal, new kinds of personal analytics apps are cropping up. Lark, for example, tracks workouts via smartphone sensors, acting as a personal coach and cheerleader users can “chat” with. The app analyzes a user’s daily activities, suggests workouts based on those activities, and sends encouraging texts—say, a compliment on your choice of a salad for lunch.


Another web app, Exist, examines data from services a person already uses—Fitbit, iCal, Twitter, and Spotify, for example—and analyzes his or her habits across the different services. The app gets smarter and more personal over time, using data from the last 90 days to suggest new fitness goals.

These technologies that can collect and leverage someone’s physical information could lead to better overall health. Leading the way is Qualcomm Life’s 2net platform, a cloud-based system that captures, transmits, and aggregates biometric data from medical devices and sensors, so health care providers, family caregivers, and patients have access to the data. The 2net hub and 2net mobile products collect biometric data via short-range radios, then encrypt it and send it to the cloud-based 2net platform via cellular technology.


Data sent to the 2net platform can be also synced with Qualcomm Life’s HealthyCircles Care coordination platform, an enterprise software-as-a-service (SaaS) solution that provides a secure communications and record-sharing infrastructure for care-team coordination. Through smart algorithms and exception-based management protocols within the HealthyCircles platform, a heart-failure patient’s blood pressure measurements could trigger an alert for a nurse case manager or doctor to check in on the patient, for example. And patients and family caregivers can monitor and manage the patient’s health status from home.

Developments like 2net and HealthyCircles are only the beginning of the quantified-self movement and health care. Connected health services will evolve with the data-collecting wearables that drive them. In-ear “earables” will measure body temperature and blood pressure very accurately. Wearables may even be invisible one day, replaced by hidden technology such as MC10’s tiny, see-through stickers—equipped with a battery and sensor—that sit on the skin.

As wearables are integrated into these health and fitness channels, health care professionals will look to the data collected on an everyday basis, rather than a yearly physical exam, ultimately shifting from an encounter-based health care to continuous care. Doctors will be more involved in a patient’s recovery and overall well-being. And an individual’s TMI data will become truly useful. It’s a paradigm shift in healthcare that will leave everyone feeling good.

HealthCoach –  The HealthCoach Prevention Program (HCPP) uses data from anthropological studies of modern day hunter-gatherer populations, Blue Zone regions around the world with high concentration of centenarians, and clinical studies to develop wellness protocols that can prevent and potentially reverse chronic disease syndromes and cognitive loss disorders.

HealthCoach Prevention Program (HCPP) Coming 2020

Gerald J. Joseph International, LLC – Thank you Qualcomm for the great insights.


Telomere extension turns back aging clock in cultured human cells, study finds.

Researchers delivered a modified RNA that encodes a telomere-extending protein to cultured human cells. Cell proliferation capacity was dramatically increased, yielding large numbers of cells for study.

A new procedure can quickly and efficiently increase the length of human telomeres, the protective caps on the ends of chromosomes that are linked to aging and disease, according to scientists at the Stanford University School of Medicine.

Treated cells behave as if they are much younger than untreated cells, multiplying with abandon in the laboratory dish rather than stagnating or dying.

The procedure, which involves the use of a modified type of RNA, will improve the ability of researchers to generate large numbers of cells for study or drug development, the scientists say. Skin cells with telomeres lengthened by the procedure were able to divide up to 40 more times than untreated cells. The research may point to new ways to treat diseases caused by shortened telomeres.

Telomeres are the protective caps on the ends of the strands of DNA called chromosomes, which house our genomes. In young humans, telomeres are about 8,000-10,000 nucleotides long. They shorten with each cell division, however, and when they reach a critical length the cell stops dividing or dies. This internal “clock” makes it difficult to keep most cells growing in a laboratory for more than a few cell doublings.

‘Turning back the internal clock’

“Now we have found a way to lengthen human telomeres by as much as 1,000 nucleotides, turning back the internal clock in these cells by the equivalent of many years of human life,” said Helen Blau, PhD, professor of microbiology and immunology at Stanford and director of the university’s Baxter Laboratory for Stem Cell Biology. “This greatly increases the number of cells available for studies such as drug testing or disease modeling.”

A paper describing the research was published today in the FASEB Journal. Blau, who also holds the Donald E. and Delia B. Baxter Professorship, is the senior author. Postdoctoral scholar John Ramunas, PhD, of Stanford shares lead authorship with Eduard Yakubov, PhD, of the Houston Methodist Research Institute.

The researchers used modified messenger RNA to extend the telomeres. RNA carries instructions from genes in the DNA to the cell’s protein-making factories. The RNA used in this experiment contained the coding sequence for TERT, the active component of a naturally occurring enzyme called telomerase. Telomerase is expressed by stem cells, including those that give rise to sperm and egg cells, to ensure that the telomeres of these cells stay in tip-top shape for the next generation. Most other types of cells, however, express very low levels of telomerase.

Transient effect an advantage

The newly developed technique has an important advantage over other potential methods: It’s temporary. The modified RNA is designed to reduce the cell’s immune response to the treatment and allow the TERT-encoding message to stick around a bit longer than an unmodified message would. But it dissipates and is gone within about 48 hours. After that time, the newly lengthened telomeres begin to progressively shorten again with each cell division.

The transient effect is somewhat like tapping the gas pedal in one of a fleet of cars coasting slowly to a stop. The car with the extra surge of energy will go farther than its peers, but it will still come to an eventual halt when its forward momentum is spent. On a biological level, this means the treated cells don’t go on to divide indefinitely, which would make them too dangerous to use as a potential therapy in humans because of the risk of cancer.

          This new approach paves the way toward preventing or treating diseases of aging.

The researchers found that as few as three applications of the modified RNA over a period of a few days could significantly increase the length of the telomeres in cultured human muscle and skin cells. A 1,000-nucleotide addition represents a more than 10 percent increase in the length of the telomeres. These cells divided many more times in the culture dish than did untreated cells: about 28 more times for the skin cells, and about three more times for the muscle cells.

“We were surprised and pleased that modified TERT mRNA worked, because TERT is highly regulated and must bind to another component of telomerase,” said Ramunas. “Previous attempts to deliver mRNA-encoding TERT caused an immune response against telomerase, which could be deleterious. In contrast, our technique is nonimmunogenic. Existing transient methods of extending telomeres act slowly, whereas our method acts over just a few days to reverse telomere shortening that occurs over more than a decade of normal aging. This suggests that a treatment using our method could be brief and infrequent.”

Potential uses for therapy

“This new approach paves the way toward preventing or treating diseases of aging,” said Blau. “There are also highly debilitating genetic diseases associated with telomere shortening that could benefit from such a potential treatment.”

Blau and her colleagues became interested in telomeres when previous work in her lab showed that the muscle stem cells of boys with Duchenne muscular dystrophy had telomeres that were much shorter than those of boys without the disease. This finding not only has implications for understanding how the cells function — or don’t function — in making new muscle, but it also helps explain the limited ability to grow affected cells in the laboratory for study.

The researchers are now testing their new technique in other types of cells.

“This study is a first step toward the development of telomere extension to improve cell therapies and to possibly treat disorders of accelerated aging in humans,” said John Cooke, MD, PhD. Cooke, a co-author of the study, formerly was a professor of cardiovascular medicine at Stanford. He is now chair of cardiovascular sciences at the Houston Methodist Research Institute.

“We’re working to understand more about the differences among cell types, and how we can overcome those differences to allow this approach to be more universally useful,” said Blau, who also is a member of the Stanford Institute for Stem Cell Biology and Regenerative Medicine.

“One day it may be possible to target muscle stem cells in a patient with Duchenne muscular dystrophy, for example, to extend their telomeres. There are also implications for treating conditions of aging, such as diabetes and heart disease. This has really opened the doors to consider all types of potential uses of this therapy.”


Krista Conger, Stanford co-authors – Jennifer Brady, PhD, and Moritz Brandt, MD; senior research scientist Stéphane Corbel, PhD; research associate Colin Holbrook; and Juan Santiago, PhD, professor of mechanical engineering.

This work was supported by the National Institutes of Health (grants R01AR063963, U01HL100397 U01HL099997 and AG044815), Germany’s Federal Ministry of Education and Research, Stanford Bio-X and the Baxter Foundation.

Ramunas, Yakubov, Cooke and Blau are inventors on patents for the use of modified RNA for telomere extension.

Gerald J. Joseph HealthCoach 2019


The “Unclogging” of Healthcare Delivery

January 2019

HealthCoach- Corporate Wellness  


A well-crafted Corporate Wellness Program adapts easily to the digital world of smartphone messaging, wearable biometric data, content delivery and modern wellness strategies.

As we move deeper into the 21st century of healthcare delivery, it has become readily apparent that the epidemic of chronic disease will remain the primary focus of most reform measures by necessity. The United States currently spends 18% of its GDP on healthcare (4,13) and at least 70% of these costs are related to the management of preventable chronic health conditions (6). These costs are projected to double every 25 years, reaching 34% by 2040, and are largely felt to be unsustainable. To respond to this crisis, the United States enacted the Affordable Care Act which seeks to incentivize improved health at a reduced cost through the use of “Big Data” to identify modifiable risk factors in a given population. The “Big Data” approach to achieving cost-effective outcomes is being used in most other industries and healthcare has finally caught on to its potential value.

According to the World Health Organization, 80% of heart disease, stroke, and type 2 diabetes could be prevented and 40% of cancer could be prevented (1). These are the major conditions that are driving increased healthcare costs within the United States. In order to harness the tremendous opportunity to save money by preventing these conditions even before symptoms have appeared, providers will need to shift resources away from costly and risky medical services to less costly and safer preventive services. The United States currently spends 96% on medical services and only 4% on prevention (6).

The United States currently spends 96% on medical services and only 4% on prevention

The Centers for Disease Control reports that the leading drivers of death and disability mostly related to these chronic conditions are poor diet, reduced physical activity, and cigarette smoking. Even though this information has been widely disseminated, less than 3% of the public is following all of the CDC’s recommendations for living a healthy lifestyle (25) and less then 50% are adhering to their medication prescriptions written mostly to stabilize the effects of these lifestyle “risk factors” (37).

This lack of adherence to lifestyle recommendations and to medication prescriptions has resulted in poor control of disease precursors like blood lipids, blood pressure, and blood sugar (targets are being met <50% of the time, 36).

To better understand why lifestyle factors are so important for health, research anthropologists report (21, 20) that the human genetic make-up has changed little in the past 40,000 years and that modern humans are genetically best adapted to:

  • Eat natural foods from the earth
  • Live outdoors with moderate exposure to the sun
  • Live among others in supportive groups
  • Sleep when the sun goes down and awaken as the sun comes up
  • Walk 5-10 miles each day
  • Exhibit a stress response to short-lived stressors and then return to relaxation

They point out that there is a mismatch between how our ancestors lived for 2.5 million years and how we began living only 10,000 years ago after the agricultural revolution (farming, domesticated animals, grains, dairy) and 200 years ago after the industrial revolution (cities, indoor living, decreased family support, decreased physical activity). These mismatches have increased dramatically in the past 30 years:

  • Sugar consumption has increased from about 2 pounds per person per year at the beginning of the 20th century to about 150 pounds today (7)
  • Processed foods made from refined sugars, cereals, refined vegetable oil, alcohol and dairy products has reached 72% of adult calorie intake (2)
  • 79.4% of Americans are physically inactive (3)
  • Vitamin D deficiency predominantly from lack of sunlight exposure has reached 82% in some populations (23)
  • 18.2 % of the population continues to smoke (6, 3)
  • 17.4% of youths age 12-17 use either alcohol or drugs (6, 3)

The best evidence tells us that these mismatches are major contributors to the onset of type 2 diabetes, heart disease, stroke, cancer, Alzheimer’s disease, liver and kidney disease, depression, falls, disability and death (6,1,3,8,9,14,22). These conditions account for most of the chronic disease burden seen around the world and data from the CDC reveals that genetic make-up contributes only 15-18% to the causes of these conditions. The other 80-85% consists of health behaviors, psychosocial factors, and environmental exposures (6, 1).

Our current healthcare system has focused resources mostly on providing care after symptoms, disease, and disability have appeared, instead of focusing on prevention (1,6,19,20,1,11). Healthcare payments tied to fee for service have incentivized care delivery to provide services after blood vessels have become “clogged” (diabetes, coronary heart disease), joints have become arthritic (osteoarthritis, rheumatoid arthritis, lower back pain), and organs have become impaired (cirrhosis, Alzheimer’s disease, kidney failure). Each year in the United States, 2.4 million angiograms, 1 million knee and hip replacements, and 51.4 million medical procedures are carried out (6).

To further frame the problem in the United States:

  • We spend 2 ½ times more then the average of our peer nations on healthcare per capita per year (25)
  • We rank 37th in overall population health compared to our peer nations (8)
  • 77% of those over age 65 have either pre-diabetes or diabetes (9)
  • Diabetes accounts for >20% of healthcare costs (9)
  • Diabetic patients cost 2.3 times more then non-diabetics each year on average for healthcare (9)
  • We rank #1 in the world in prescription drug use (5)
  • 76% of every clinical encounter in the U.S. involves a medication (28)
  • 80% of the worlds opiate pain pills are prescribed in the United States (27)
  • 70% of Americans take one medication, 50% take two, and 20% take five. (26)
  • 1/3 of older adults over age 65 fall each year and that increases to 50% for those over age 80 (6)

Now more then ever, we can’t afford to wait for symptoms, disease, or disability to occur before we actively and continuously engage patients in the work of self-care. We need to implement a prevention and wellness delivery system that supports patients in the work of building resiliency by self-managing conditions and lifestyle particularly in between acute episodes of care.

We can’t afford to wait for symptoms, disease, or disability to occur

Our emphasis on pharmaceutical and medical service prescription for chronic disease is unsustainable and has to change if we are to have the necessary resources to maintain our quality of life and our position in the world as a major power. We must now shift to a lower cost prevention and wellness model of care for chronic illnesses and this is exactly what leaders in healthcare innovation are pursuing. By improving health outcomes through this lower cost approach, we could allocate some of these saved resources to other societal problems such as crime, education, poverty and job creation (4).

Our emphasis on pharmaceutical and medical service prescription is unsustainable.

Lessons learned from Medicare’s pioneer ACO pilot programs tell us that we must reduce medical services by preventing “rising risk” patients from becoming “high risk” patients in order for healthcare to become financially viable in the long term (19). This is why the Institute of Medicine, the CDC (6), the Institute for Healthcare Improvement (33), the American Academy of family Physicians (34), and the Centers for Medicare and Medicaid (30) are calling for a shift in care away from reactive disease management to proactive disease prevention.

These organizations are calling for a reorganization of primary care into highly functioning physician-led prevention teams like the patient-centered medical home where each member of the team takes on different responsibilities and works at the top of their license. The team focuses on prevention and wellness of their assigned population and engages patients in the work of self-management.

Self-management support is a KEY intervention for preventing chronic illness (35) but physicians have received little training in team-based care and in condition or lifestyle self-management prescription (38). In addition, both providers and patients have become accustomed to the medication or procedure-based encounter pointing to the additional challenge of creating a “culture” of prevention and wellness (24, 28).

Self-management support is a KEY intervention for preventing chronic illness

Pre-existing models of successful self-management support programs include cardiac rehabilitation (32% improvement in cardiac mortality) (17), pulmonary rehabilitation (37% reduction in acute hospitalizations for COPD) (16), and the diabetes prevention program (70% reduction in onset of diabetes for older pre-diabetic patients) (14).

The Institute of Medicine has recently called for medical education reform to meet the new demand for prevention and wellness delivery within primary care (10) but this could take many years to implement once medical schools finally embrace these recommendations.

To further elucidate the healthcare “cultural” problem, patients report that they would rather take medications or undergo surgery then make changes in their health behaviors to reduce chronic disease risk factors (24). In order to change this paradigm, the American Hospital Association has called for the enactment of a “culture of wellness” throughout our systems of care (29).

They recognize that the cultural disconnect between the OLD way of reactive care delivery and the NEW way of preventive care delivery. Changing culture takes time and this will be a significant challenge for 21st century healthcare. The providers who succeed in making this cultural shift sooner then later will be the winners within the NEW value-based payment system that is emerging (19).

Patients report that they would rather take medications or undergo surgery then make changes in their health behavior

Leaders from the Robert Wood Johnson Foundation (11), from Kaiser-Permanente (31), from Cleveland Clinic (32) and many other integrated care systems (18) are working to prevent disease at every level within the chronic disease lifecycle. They are calling for prevention and wellness integration as a primary focus for better outcomes delivery at a reduced cost. This is consistent with Medicare’s triple aim vision for the future of healthcare (18).

With the shift to electronic medical records and the push to get patients “into the system”, more providers will be able to use BIG DATA to identify the right risks for prevention so that limited resources can be targeted in the right way. This is what the Robert Wood Johnson foundation calls “A Prescription for Health” (12) and this is what will sustain healthcare delivery in the long term.

HealthCoach – tracks biomarker information like steps per day, weight (loss or gain), BMI, continuous blood sugar, sleep, hydration and food choices – as well as a host of other cohorts through fitness tracking technology.

HealthCoach – allows doctors, participants and health coaches to use secure HIPAA messaging or video conferencing to help with better food choices, to encourage consistent steps per day, to insure safe weight loss and to communicate data back to the doctor for reassessment every 90 days.


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