REPEALONOMICS: Taxpayer funded TACTICS for Political OPTICS


Repealonomics: Taxpayer funded TACTICS for Political OPTICS.

The Affordable Care Act of 2010 was passed with the intent of providing affordable access to quality healthcare to all Americans.

The Affordable Care Act puts in place strong consumer protections, provides new coverage options and gives you the tools you need to make informed choices about your health. In this section, learn about how the law affects you.
To explore details please click here.


The discussion around repealing that Act is costing can impact tax payers in three ways.

First of all, the GOP has raised a Vote to repeal 33 times so far. The First vote was on Jan of 2011 and the latest one was in July of 2012. Each week of the House of Congress costs Twenty Four Million dollars to the tax payer. In addition clogging the docket also deprioritizes other key initiatives. Continuing this trend only delays us from moving forward.

Secondly there is a cost of undoing aspects of the Act that’s already been implemented or is in the process for implementation. To list some:

Effective Jan. 1, 2010: Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit.

National program established July 1, 2010
A Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state has chosen not to do so, a plan has been established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited.

Effective for health plan years beginning on or after September 23, 2010
Under the new law, young adults are allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Check with your insurance company or employer to see if you qualify.

To explore details  of repeal votes please click here.


To explore details of Parts of Act already in place please click here:


Thirdly, the repeal will have impacts on the Deficit. If the law is enacted, CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of $1,168 billion over the 2012–2022 period—compared with $1,252 billion projected in March 2012 for that 11-year period—for a net reduction of $84 billion. (Those figures do not include the budgetary impact of other provisions of the ACA, which in the aggregate reduce budget deficits.)CBO and JCT now estimate that fewer people will be covered by the Medicaid program, more people will obtain health insurance through the newly established exchanges, and more people will be uninsured. The magnitude of those changes varies from year to year.

In 2022, for example, Medicaid and the Children’s Health Insurance Program (CHIP) are expected to cover about 6 million fewer people than previously estimated, about 3 million more people will be enrolled in exchanges, and about 3 million more people will be uninsured.

Conversely if the Act is Repealed, it would cause a net increase in federal budget deficits of $109 billion over the 2013–2022 period.

To explore details of Budget impacts please click below:
Impactsof insurance coverage provisions 
Impactsof Repeal 

Sweetopia



How do you like your coffee? Cream and sugar? Black? Or with a sugar substitute?

American adults consume an average of 22 teaspoons a day, or about 355 calories, from added sugars. Every teaspoon has 15 to 16 calories. Sugar is "toxic" in the amount it's consumed by Americans, says pediatric endocrinologist Rob Lustig, a professor of pediatrics at the University of California-San Francisco and one of the country's most vocal critics of added sugars.

A little bit is OK, but it's the quantity that people are consuming that's harmful, Lustig says. "Everyone knows the dose determines the poison. I agree with that. There is a threshold, and right now we are way above that threshold."

The heart association recommends that most American women consume no more than 6 teaspoons a day, about 100 calories, from added sugars, Johnson says. For men, it's 9 teaspoons or about 150 calories. Kids should limit their intake to about the same amount, she says.

The long history of sugar is interwoven with that of trade, religion, colonialism, capitalism, industry and technology. The people of New Guinea were probably the first to domesticate sugarcane, sometime around 8,000 BC; solid sugar is not mentioned in the historical record until AD 500, in India. Originally, people chewed sugarcane raw to extract its sweetness. Indians discovered how to crystallize sugar during the Gupta dynasty, around 350 AD

The first sugar substitute, saccharin, was discovered in the late 1800s and gained prominence in manufacturing during the World Wars, when sugar was rationed. The business of sugar-free foods and drinks began to boom in the 1960s when clinicians realized the importance of controlling weight gain in the management of diabetes.

Since then, as people became more health-conscious and wanted to shun sugar, manufacturers responded with a host of sugar substitutes. They are:

Aspartame, approved in 1981 by the U.S. Food and Drug Administration (FDA) and now in more than 6,000 foods and drinks


  • Acesulfame-K, FDA-approved in 1988
  • Sucralose (Splenda, SucraPlus), approved in 1998 for limited use and in 1999 for general use
  • Neotame, approved in 2002

Now we call them artificial sweeteners. How do they work? The basic idea of what would make a good sugar substitute is simple.

On the surface of the tongue, certain proteins act as detectors for specific tastes. The sweetness receptor is made of two proteins in what is believed to be a structure like a Venus’ flytrap. When a sugar molecule attaches to the receptor, the receptor jogs neurons that send a signal to the brain that says something sweet has just been tasted. An artificial sweetener is simply a calorie-free substance that excites the same sweetness receptors.

The pros and cons of sugar versus substitutes have been a popular topic for debate over the years. The topic of sugar substitutes can be complex and confusing. One problem is that the terminology regarding sugar substitutes is often open to interpretation. For instance, some manufacturers call their sweeteners "natural" even though they're processed or refined, as is the case with stevia preparations. And some artificial sweeteners are derived from naturally occurring substances — sucralose comes from sugar, for example. Sometimes sugar substitutes are categorized by whether or not they contain calories.

As part of an overall healthy diet, sugar substitutes are believed to reduce calories and the risk of cavities. Interestingly, controlled studies that compare weight loss between people who use sugar substitutes and those who consume sugar show very little difference in weight loss between the two groups, although over the long term, sugar substitutes can help maintain weight loss.

Sugar is headed towards a new world of scrutiny and regulation. Some key trends in the public and private sector topping news:


  • Walt Disney announced that it's going to stop advertising junk food to kids on its TV channels, radio station and website by 2015
  • New York Mayor Michael Bloomberg outlined a plan to ban large-size sugary beverages sold at the city's restaurants, movie theaters, sports venues and street carts.
  • Some states and cities are working on "soda taxes" on sugary drinks. And in recent years, major health groups have discouraged the consumption of large amounts of added sugars.

Increasingly, the focus is being placed on sugar, the sweetener with a history that goes back 8,000 years. Is something so sweet really that harmful to health? Or is it just being maligned as people look for a scapegoat for the obesity epidemic.

The American Heart Association says in a statement that research has tied a high intake of added sugars to many poor health conditions, including obesity, high blood pressure, type 2 diabetes and other risk factors for heart disease and stroke.

For additional details check outè

Health identity: 3 Key questions answered


1. What constitutes a health identity?
We are all aware of the Social Security Number- it uniquely identifies us and our financial behaviors making it easy for us to borrow money, get insurance and much more. But when it comes to our health and medical records it is not a very consistent or standardized experience across the physicians, labs, drugstores or hospitals that we go to. Topping it all is the fast evolving online health care and the imperative for a comprehensive digital identity that collects, trends and makes all aspects of your health data securely and accurately available to those that need to interact with the information in a timely manner.

There are several acronyms you hear like PHR, EMR/ EHR, HRA, HIPAA etc, that describe platforms that digitize medical records or provide consumer protection of the information.

EMR/ EHR: Electronic Medical (or Health) Records are safe and confidential record your doctor, other health care provider, medical office staff, or a hospital keeps on a computer about your health care or treatments

PHR: Personal Health Record is a secure collection of all aspects of your health services, insurance information, test results, treatments or a collection of all your EMR / EHRs in one place

2. How do you contribute?
HRA: Health Risk Assessment(s) are evaluations that your providers (physicians, hospitals etc) and payors (insurance companies, employers) conduct to capture at a moment of time your health state. You fill out several questionnaires when signing up for insurance or seeing a doctor for the first time. These are all captured in the form of PHRs or EMRs by entities that provide adhoc or recurring health care services for you.

3. How are you protected?
HIPAA: Health Insurance Portability and Accountability Act (1996) is a privacy rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.


Allergy – Top 10!



Itchy watery eyes, nasal congestion, sneezing…..sounds familiar?  Spring is here and so are your allergies

So what is it?
An allergy is a reaction of your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Allergies are relatively common. Both genetics and environmental factors play a role. The immune system normally protects the body against harmful substances, such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless and in most people do not cause a problem. But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, it releases chemicals such as histamines which fight off the allergen.

Spring is a season when may deal with aggravated symptoms. Here are some common dos and don’ts that can help manage your symptoms and enjoy the season

What helps?
1.     Butterbur extract and tablets are widely used as natural treatments for allergies.
2.     Green herbal tea contains antioxidants that reduce over production of inflammatory substance, histamine.
3.     Traditionally, organic natural honey has been prescribed for allergies. The bees eat the pollen that’s in your region of the country, then they produce the honey and you consume that, so it’s kind of like a mini allergy shot.
4.     Including detoxifying spices in your daily diet might help. Turmeric in particular has anti-allergy, immune-balancing effects.
5.     Vitamin C is also believed to help. Citrus fruits like Oranges, Tangerine or Lemons are great natural sources of Vitamin C
6.     Grape seed extract, which can be found in vitamin or health food stores, has been shown to be effective.
7.     Sinus Massage can help relieve symptoms. This massage concentrates on the face, head, neck and ears to move along blocked residue as well as enhance blood flow to get the sinus cavity clear and healthy.
8.     Using a Neti Pot to Clean your Nasal passage with saline solution also seem help many
9.     Several Yoga exercises focused on controlled breathing help relief symptoms of allergy. To name some, Shoulder Stand and the Bridge Pose.
10.  Finally, don’t open your windows. Letting  allergens into your house can aggravate your symptoms significantly.

Spring into Spring with nine flavors of the season to suit your palate and health!


With the first day of spring here, we have a season full of budding and blossoming to enjoy. All around us are trees coming back to life. Its time to spring clean our kitchen and pantry and enjoy the best of the season. Here are some tips on fruits, vegetables and herbs from list toppers. Delightful recipes with their bonus health benefits.

Create your signature fruity sensations!
 Cherries: Cherries are one of North America's only native fruits, although they grow around the world. A perfect balance of sweet and tart, they’re juicy and give a little snap when you bite into them, also delivering a dose of potassium, vitamin C and fiber. Try to buy ripe cherries in bulk: that way you’ll have plenty for snacking, enough left to make these tasty treats and extras that you can freeze for chillier days. Experiment away with a multitude of recipes http://www.eatingwell.com/recipes_menus/recipe_slideshows/sweet_cherry_recipes
          
Rhubarb: A great source of vitamin C, Calcium, Fibers and Vitamin K,  rhubarb is incredibly versatile with many culinary uses. Rhubarb dates back to 2700 BC where it was grown and used in China for medicinal purposes.  It is thought that it made its way to America in the late 1700’s and began growing in Maine and then spread into Massachusetts. Try out more than 300 recipes and add your own at http://www.rhubarbinfo.com/recipes
  
Strawberries: One cup of strawberries contains over 13% of the RDA of dietary fiber, yet only 43 calories. The dietary fiber in strawberries helps to keep digestion regular, as well as lowers blood pressure and curbs overeating. Buy them plump, firm, fragrant berries that are shiny and bright red. : Wash with warm water, discard any moldy berries, wrap in paper towel or plastic loosely and refrigerate for 3 – 5 days. If you don’t like them fresh, here are some great recipes to use them in http://www.eatingwell.com/recipes_menus/collections/healthy_strawberry_recipes
  
Sizzle it with vegetable delectable’s:
 Artichokes:  Artichokes are actually a flower bud - if allowed to flower, blossoms measure up to seven inches in diameter and are a violet-blue color. Artichokes are a close relative to the thistle. Squeezed, a fresh artichoke will make a squeak. Artichokes are a good source of vitamin C and dietary fibers. To get the maximum taste and tenderness, cook as soon as possible. Do not stock up on artichokes. Refrigerate unwashed, in a plastic bag, for up to 1 week. Try some of these innovative recipes http://allrecipes.com/recipes/everyday-cooking/seasonal/spring/artichokes/viewall.aspx?page=1

Asparagus: This vegetable is sometimes referred to as the aristocrat of vegetables. Many Greeks and Romans not only appreciate asparagus for its taste but also believe it possesses medicinal properties from alleviating toothaches to preventing bee stings. Such things are mythical, but asparagus does contain a good supply of vitamins and minerals. Here are some exotic recipes http://www.washingtonasparagus.com/default.cfm?body=recipes.cfm

Radish: Radishes were first cultivated thousands of years ago in China, then in Egypt and Greece. Radishes were so highly regarded in Greece that gold replicas were made. Radishes are root vegetables that resemble beets or turnips in appearance and texture, but have a distinct flavor. Radishes are a very good source of vitamin C and also contain significant amounts of calcium, magnesium, folate, and potassium. Practitioners of natural medicine prize radishes for their ability to stimulate digestion, cleanse the system, and alleviate congestion and a sore throat. Try out some amazing recipes http://www.bonappetit.com/ideas/radish-recipes/search

Spice it up with seasonal herbs:
Lavender: Lavender isn't just for aromatherapy products. This wonderfully fragrant flower is also edible and is surprisingly versatile in the kitchen. Dried lavender flowers can be used to make teas or extracts as an essence in baking. To try out delicious recipes using lavender, click here: http://www.epicurious.com/recipes/food/views/Honey-Lavender-Ice-Cream-108526
  
Thyme: Thyme is a uniquely flavored herb that has many tasty varieties, including lemon thyme, and many delicious uses. Fresh thyme can be whisked into sauces or salad dressings, stirred into rice and grain salads, rubbed onto pork and other meats, sprinkled onto potatoes and eggs, used as garnish for fish, infused into olive oil or vinegar or added to desserts for a special treat.
Explore a variety of recipes using thyme and enjoy http://www.bbc.co.uk/food/thyme

Parsley: Parsley can be whirred into pesto, stirred into soups and stews, added to sauces, tossed in green or grain salads, combined with other herbs and olive oil to form a paste to rub on meats and fish and sprinkled onto just about any savory meal as a colorful finish. Here is a delightful recipe from Argentina http://www.asadoargentina.com/parsley-garlic-chimichurri-recipe/

An ounce of prevention is worth a pound of cure

Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 % of the nation’s health spending – and often are preventable.

High-quality preventive care helps Americans stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce costs.  And yet, despite the proven benefits of preventive health services, too many Americans go without needed preventive care because of financial barriers.

Preventive services with a “grade” of A or B, like screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

An estimated 31 million people in new employer plans and 10 million people in new individual plans will benefit from the new prevention provisions under the Affordable Care Act. The number of individuals in employer plans who will benefit from the prevention provisions is expected to rise to 78 million by 2013, for a total potential of 88 million Americans whose prevention coverage will improve due to the new policy.

Policy Promoting Prevention: What are some of the key ways in which public policy is focusing on Prevention?

ü  Prevention and Public Health Fund: The Affordable Care Act makes an unprecedented investment – $15 billion over 10 years – in health care programs and providers to prevent disease, detect it early, and manage conditions before they become severe. 

ü  Prevention and Wellness in Medicare and Medicaid: The Affordable Care Act also provides for prevention without cost-sharing under Medicare.  The new law will also provide enhanced Federal Medicaid matching funds to States that offer evidence-based prevention services.

ü  Prevention and Public Health Council: The Affordable Care Act creates a National Prevention, Health Promotion, and Public Health Council, composed of senior government officials, to coordinate Federal prevention activities and design a National Prevention and Health Promotion Strategy with input from stakeholders and communities across the country to promote the nation’s health.

ü  Recovery Act: Provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction program, and efforts to reduce health-care-acquired infections.

Employers commitment to wellness: Is incentivizing the way?
In addition to the trends in public health policy the Private sector has been focusing on wellness as well. Many employers are taking measures to combat rising health care costs, in some cases by providing access to employee assistance programs and wellness benefits, both of which attempt to help people adopt preventive health measures and more healthful habits. Data from the National Compensation Survey show that a relatively small percentage of workers have access to these kinds of benefits, but the trends suggest that the proportion is increasing over time.

Data from the National Compensation Survey (NCS) for March 2010 show that three-fifths of private employers made health care benefits available to their workers. Some employers, perhaps heeding the wisdom of Benjamin Franklin that “an ounce of prevention is worth a pound of cure,” elect to do more for their employees. Employer-sponsored wellness programs that include help with nutrition, incentives to exercise, or smoking cessation are available to a third of private sector workers.

There was widespread agreement among wellness companies, benefits consultants and employers that financial incentives dramatically increase wellness participation—for example, boosting HRA completion from 20 percent to between 50 percent and 90 percent. Cash incentives and insurance premium contribution reductions are the most common form of financial incentive; gift cards and contributions to health savings accounts or health reimbursement arrangements also are used by some employers.

Most benefits consultants and wellness vendors believed that $100 is the “sweet spot” for an incentive for a “single instance of behavior,” such as HRA completion or participation in a specific wellness activity. There was consensus that the incentive should be paid soon after the activity is completed, so that the reward is strongly linked to successful activity completion in participants’ minds. There was also common agreement that offering incremental incentives adding up to a substantial total incentive over the course of the year is preferable to offering a large lump sum for satisfying many requirements, because the latter may be perceived as too insurmountable a barrier to generate much enthusiasm or participation among employees.

While focusing on prevention is key to embracing wellness, and incentivizing is key to adoption, ensuring HIPAA compliance is critical.

HIPAA Nondiscrimination Requirements: What are the five requirements for wellness programs which base a reward on satisfying a standard related to a health factor?

ü  The total reward for all the plan’s wellness programs that require satisfaction of a standard related to a health factor is limited–generally, it must not exceed 20 percent of the cost of employee-only coverage under the plan. If dependents (such as spouses and/or dependent children) may participate in the wellness program, the reward must not exceed 20 percent of the cost of the coverage in which an employee and any dependents are enrolled.

ü  The program must be reasonably designed to promote health and prevent disease.

ü  The program must give individuals eligible to participate the opportunity to qualify for the reward at least once per year.

ü  The reward must be available to all similarly situated individuals. The program must allow a reasonable alternative standard (or waiver of initial standard) for obtaining the reward to any individual for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard.

ü  The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard (or the possibility of a waiver of the initial standard).

Bottom Line: What does this mean for you?
Ø  Visit http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html to find out more on how you can take advantage of upcoming changes
Ø  Talk to your primary health care provider to make sure you are getting the tests and screening that apply to your individual needs
Ø  Reach out to your HR partner at work to see what incentives are available at work. You benefit from making these changes as much as your employers
Ø  Visit your health insurance companies website to better understand all benefits and tools

USA- #1 in Healthcare Spend but #45 in life expectancy: Global ranking mystery

We have talked about the correlation of mental health and wealth – if you are wealthy are you healthy and happy? The answers were intriguing.[1] Now let us look at it from a slightly different angle, is there a connection between how wealthy a country is and its overall life expectancy?  While poverty correlates strongly to poor health and longevity, the reverse is surprisingly far from reality.

Let us look at two economic indicators to evaluate the correlation.
Q1. How much are wealthy nations spending on healthcare as a portion of their GDP?
Q2. How is the spend translating into long and healthy lives for their citizens?

 Organization for Economic Co-operation and Development (OECD) was established in 1960 to promote policies to improve the economic and social well-being of people around the world. The OECD provides a forum in which governments can work together to share experiences and seek solutions to common problems.  As part of one of their global data analysis initiatives they maintain trends of health Care spending by Country and how they compare to their GDP. United States tops the list at 17% in 2009, with projections to indicate this global leadership position[2].


Healthcare Spending as part of GDP


So as a country spending top dollars in healthcare, how are we doing in life expectancy? Are we the absolute best in living long healthy lives?  To answer this question empirically let us look at the following study conducted by - United Nations, Department of Economic and Social Affairs, Population Division (2011), World Population Prospects: The 2010 Revision.[3]  The top ten countries does  not include USA. In fact USA ranks #45 on this list. Among the top on the list are Japan, China, France, Spain, Switzerland and Italy.

The question then becomes, what explains the gap? Why is spending the top dollars in healthcare not translating into Americans leading the longest and  healthiest lives. Quality of medical care in USA competes well globally. Crème dela crème of the global health care practitioners are working in a supreme capitalistic free democracy serving the system – yet we are #45 in life expectancy. 

Is it Lifestyle? Is It Nutrition? 
According to USDA, the share of income or private consumption expenditure (PCE) spent on food is often used as an indicator for the relative well-being of a country. What is unique in USA in Food Spending? [4]

In the U.S., the rise in food spending as income increases is driven largely by food away from home, which captures two-thirds (65 percent) of the more than $450 increase in monthly household food spending between the lowest and the highest income groups. The highest income households spend nearly half (47 percent) of their food budget on food away from home, almost double the share among the lowest income households.

U.S. spending on fruit and vegetables rises only minimally across income levels. Households in the highest income group—which have an average of $8,000 more in after-tax monthly income than households in the lowest income group and spend over $450 more on food—choose to spend just $26 more per month on fruit and vegetables, which translates into an additional 21 cents per person per day on fruit and vegetables. The small change in spending on fruit and vegetables may explain why many high-income households also fail to meet intake recommendations for fruit and vegetables, and suggests that income and prices are not likely the main factors behind the low consumption of fruit and vegetables among low-income households, as is commonly believed.

So here we are, leaders in GDP, education and healthcare spend, chosing to pay top dollars for bad nutrition and a bad lifestyle that makes us unhealthier everyday as we continue to debate the Budget Deficit and Health Care spend!


[1] http://myayuvia.blogspot.com/2011/07/health-and-wealth-is-there-connection.html
[4] http://www.ers.usda.gov/AmberWaves/February08/Features/CovergingPatterns.htm


5 Tips for Health on the road - abroad



2012 has started off with great enthusiasm and promise for an exciting year of rebound. As work takes you abroad for your company’s global initiatives, or you plan an exotic tropical vacation here are some quick tips from the World Health Organization on planning for a healthy trip.

1. Medical consultation before travel
Travelers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should take place at least 4–8 weeks before the journey and preferably earlier if long-term travel or overseas work is envisaged. Dental and gynecological check-ups are advisable before prolonged travel to developing countries or to remote areas. This is particularly important for people with chronic or recurrent dental or gynecological/obstetric diseases or problems.

2. Assessment of health risks associated with travel
Medical advisers base their recommendations, including those for vaccinations and other medication, on an assessment of risk for the individual traveler, which takes into account the likelihood of acquiring a disease and how serious this might be for the person concerned. Key elements of this risk assessment are the pre-travel health status of the traveler, destination(s), duration and purpose of travel, the mode of transport, standards of accommodation and food hygiene, and risk behavior while travelling.

3. Medical kit and toilet items
Sufficient medical supplies should be carried to meet foreseeable needs for the duration of the trip.
A medical kit should be carried for all destinations where there may be significant health risks, particularly those in developing countries and/or where the local availability of specific medications is uncertain. This kit will include basic medicines to treat common ailments, first-aid articles, and any other special medical items, such as syringes and needles (to minimize exposure to blood borne viruses), that may be needed and can in some cases be used by the individual traveler.

4. Insurance for travelers
Travelers are strongly advised to travel with comprehensive travel insurance as a matter of routine and to declare any underlying health conditions. Travelers should be aware that medical care abroad is often available only at private medical facilities and may be costly. In places where good-quality medical care is not readily available, travelers may need to be repatriated in case of accident or illness.

5. Medical examination after travel
Travelers are advised to have a medical examination on their return if they:
§  suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, or chronic respiratory disease or have been taking anticoagulants;
§  experience illness in the weeks following their return home, particularly if fever, persistent diarrhea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs;
§  they received treatment for malaria while travelling;
§  may have been exposed to a serious infectious disease while travelling;
§  have spent more than 3 months in a developing country.

Meaningful milestones: connecting health, wellness and happiness.

Aging is an absolute certainty that we cannot avoid or postpone. We can prepare ourselves, mentally and physically for what’s to come, and enjoy the process as well.

While we have financial planners guiding us through balancing what we earn into buckets of saving, investing and spending, we seldom get any guidance with our emotional investments and nutritional priorities.

Here are some very broad spectrum generalizations.  A good number of us will encounter most of these milestones. Our overall happiness and wellness will be entwined with the level of forethought we put in at each step.

How we eat, how much we drink or smoke, what level of physical activity we maintain and how we manage stress will depend upon the choices we make in life that defines us and helps us age gracefully.

By living deliberately in the present moment, we can take small and balanced steps in each decade of our lives towards making the next one even greater.

Teens
ü  Friendships: How we define ourselves in our teens often is closely connected with how we choose our friends. Friendships made at this age lasts a lifetime and becomes essential in the support structure we create to face and conquer various challenges in our lives.

ü  Academic Pursuits: What interests us in our world of academia also becomes very crucial in how we define our adult lives, our happiness and our earning capabilities. Learning from our teachers, parents and mentors is key in making the right choices that gives us the best in our learning’s as well as taking us into vibrant and exciting careers

Twenties
ü  Relationships: As we venture out into the adult world, we start seeking the perfect mate. While the process can be fun or disastrous, it is imperative that we define what “Perfect” is. It is better to have a clear set of criteria early on than to invest in a long term relationship or worse a marriage that is doomed for the inevitable “D”.

ü  Career Pursuits: Choosing a career path simply to please a parent or a spouse or simply because its lucrative, can work in the short term. In the long term will become troublesome through stress, dissatisfaction, even depression. The pursuit should be in the direction where we look forward to get out of bed every Monday morning because we feel that we can make a difference, and way beyond the checking account.

Thirties
ü  Parenting: Planning and preparation is key to successful parenting. Readiness should be comprehensive - financially, emotionally, physically, mentally – together and individually. Prioritizing ourselves and our relationships as parents will be as important as prioritizing our children’s needs. Without the balance, there will be much to lose in the long run.

ü  Divorce: Statistics indicate more separations than long term togetherness. While no one wants to or plans for their relationships to fail, it is important to know when things are not working. It is essential to confront conflict. Working through the process of separation with respect and patience and learning to let things go is vital to moving on and finding new sources of happiness and companionship.

Forties
ü  Responsibilities: As we enter our forties we will find ourselves pulled in multiple directions. Aging parents needing our help, teenage children acting out, pressures at work and midlife crisis of friends and spouses. Balancing each role that we play at this age becomes a juggling act; one not managed well will manifests in early onset of mental and physical health issues.

ü  Nourishment: This is also the decade when we need to start listening to our body if we already haven’t. Paying attention to dos and don’ts of nutrition is critical in avoiding kicking off early dependence on pharmaceuticals.

Fifties
ü  Community: With a couple of decades dedicated to consuming, this is when many of us actively initiate contributing; in public service, charity or deeply embedded creativity. This is when we look beyond proving to others what we are capable of and transition to proving to ourselves how we can make a difference.

ü  Fitness: Staying active as we get older becomes tougher. Pain from aging or chronic conditions, and sports injuries are few of the challenges we face. Picking up new ways to stay fit become important. Walking for 30 minutes at least five times a week or taking an yoga or a tai chi class would be a gentle way towards keeping fit.

Sixties
ü  Retirement: Transitioning from the routine of a job can pose challenges emotionally and mentally. Losing the daily discipline and the social interaction could cause loneliness and depression. It is important to plan social activities through volunteer work or hobbies to keep busy and mentally stimulated.

ü  Healthcare: For many there is a knowledge gap of how healthcare works between an employee paid group insurance and Medicare. It is important to get educated in advance and plan well for preexisting conditions, prescription medications and frequently needed diagnostics.

Seventies and beyond
ü  Spirituality: As we approach the twilight of our lives, we connect with our souls at deeper levels. Some of us reach into religion and some simply become more spiritual. It is about managing the anxiety around the inevitable and cherish life and its achievements

ü  Legacy: Our legacy is a collection of work, our children and memories in the minds of those we connected with. How we collect and gather and give is up to us. Planning this transition is as important for us emotionally and spiritually as it is for those we would leave behind

Remember it is never too late to begin. Wherever you are, in the continuum of space and time, embracing wellness will always positively impact your mind body and soul.

“Age is an issue of mind over matter. If you don’t mind then it doesn’t matter.” Mark Twain

Urbanization - does it help or hinder Health?

The rapid increase of people living in cities is one of the most important global health issues of the 21st century.

A study was conducted by the World Health Organization in partnership with UN-Habitat aimed at unmasking and overcoming health inequities in urban settings and includes practical examples and recommendations on specific evidence-based interventions.

Through a novel analytical approach, this report, outlines the crucial finding that urban averages often mask hidden pockets of ill-health and overlooked populations.

Take this quiz to find out more about how urbanization and health are connected http://www.hiddencities.org/quiz.html

The list of potential urban hazards and associated health risks is long: substandard housing and crowded living conditions, problems with food and water safety, inadequate sanitation and solid waste disposal services, air pollution, and congested traffic, to name a few.

Many cities face a triple threat: infectious diseases thrive when people are crowded together under paltry living conditions. Chronic, noncommunicable diseases are on the rise with the globalization of unhealthy lifestyles, which are facilitated by urban life – tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol. And urban health is further burdened by accidents, injuries, road accidents, violence, and crime.

For a detailed in-depth analysis, please download article at :  http://www.hiddencities.org/downloads/WHO_UN-HABITAT_Hidden_Cities_w.pdf

Optimizing Health and Wellness in 2012

2012: As we make resolutions for the New Year, it is important to make little changes that are sustainable. The easier it is to make the change the longer we will be able to embrace it for.  Optimizing what we eat, how much we work out and rest, all adds up to our overall health.

Eating right:
We all focus on counting calories. But balancing nutrition is a lot more than calories. It is important to keep  fat, cholesterol, sugar and salt under a certain amount daily while ensuring enough vitamins and minerals. Finally based on our gender, age and weight, it is also important to balance proteins and carbs in each meal.

 Department of Agriculture and Department of Health and Human Services provides science-based nutrition guidance for Americans ages 2 and older to promote healthy lifestyles and dietary habits. Some simple tools to customize our  meals are available @ https://www.choosemyplate.gov/SuperTracker/default.aspx

Staying fit
Walking, running, working out, taking the stairs all count towards exercise that keeps we fit. 30 Minutes every day or 150 minutes a week. Count our steps every day up-to 10,000 steps a day which works out to walking about 5 miles. And in a recent study, walking that distance proved critical to both cardiovascular fitness and blood sugar levels. A science-based guidance to help Americans aged 6 and older improve their health through appropriate physical activity can be found Physical Activity Guidelines from US Department of Health and Human Services @ http://www.health.gov/paguidelines/guidelines/default.aspx

Resting well
According to Center for Disease Control, while we often consider sleep to be a “passive” activity, sufficient sleep is increasingly being recognized as an essential aspect of health promotion and chronic disease prevention in the public health community. Insufficient sleep is associated with a number of chronic diseases and conditions—such as diabetes, cardiovascular disease, obesity, and depression—which threaten our nation’s health.

Although individual needs may vary, adults typically need between 7 to 9 hours of sleep per night. It is difficult to make up for lost sleep because each time we don't get enough sleep, we add to our sleep debt (the accumulated sleep that is lost due to poor sleep habits, sickness, awakenings due to environmental factors or other causes.) As a result, the sleep debt may make we feel sleepier and less alert at times.

Many people follow an exercise program to stay healthy. It’s important to have a smart sleep program as well. Detailed information on facts, myths, disorders and solutions about sleep are available @ http://www.cdc.gov/sleep/about_sleep/index.htm

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