Of All Forms of Inequality, Injustice in Health Care is the Most Shocking and Inhumane: Listening to Martin Luther King, Jr.

Today as we appreciate the legacy of Martin Luther King, Jr., I post a photo of him in my hometown of Detroit in 1963, giving a preliminary version of the “I Have a Dream” speech he would deliver two months later in Washington, DC.               Wisdom from the speech: “But now more than ever before, America is forced to grapple with this problem, for the shape of the world today does not afford us the luxury of an anemic democracy. The price that this nation must pay for the continued oppression and exploitation of the Negro or any other minority group is the price of its own destruction. For the hour is late. The clock of destiny is tickling out, and we must act now before it is too late.” As I meditate on MLK, I think about health equity, especially potent inspiration in light of Americans’ declining lifespans, tragic maternal and child mortality outcomes, ubiquitous food insecurity, and epidemic mental health crisis. By now, most clued-in Americans know the score on the nation’s collective health status compared to other developed countries — especially striking differences between black people and whites in death rates and complications due to COVID-19. Suffice it to say, We’re Still Not #1 for health outcomes, albeit we’re the biggest spender on healthcare, per health citizen, in the world. Underneath that statistic is a shameful state of health affairs: that people of color and the LGBTQ communities in the U.S. have lower quality of health and many services than white people do: Black women have higher breast cancer death rates than White women Asian women are less likely than White women to receive a pap smear Hispanic women are more likely than non-Hispanic White women to be diagnosed with cervical cancer at an advanced stage Rates of hospital admissions for uncontrolled diabetes are higher for Black women than for women in other racial/ethnic groups The rate of hospital admissions for lower extremity amputations due to uncontrolled diabetes is higher for Black women than White women The rate of new AIDS cases is higher for Black and Hispanic women than for non-Hispanic White women. Black and Hispanic men had even higher rates than women, as well as higher rates than non-Hispanic White men Black women receive treatment for depression less frequently than White women and Hispanic women received treatment less frequently than non-Hispanic White women Hispanic women received treatment for substance abuse less frequently than non-Hispanic White women.             If these statistics don’t move you, then here’s a finding from the National Academy of Science’s Shorter Lives, Poorer Health that might surprise you: today, people in the U.S. under 50 have poorer health outcomes than our cohorts in other developed countries. For women under 50, we’d rather live in other industrialized countries where fewer women under 50 die from noncommunicable diseases, heart disease, injuries, perinatal conditions, drug-related causes, and communicable and nutritional conditions. Yes, more younger women in the U.S. — the wealthiest nation in the world — lose more life-years due to malnutrition, infectious disease, injury, and lifestyle-borne diseases like diabetes and heart disease than in our fellow rich countries. And in 2018, a new statistic emerging that the rate among women for deaths due to opioid overdoses rose. One of the most heartbreaking aspects of this concerning trend is a link to pregnant women and newborns. What’s new today versus previous MLK Days is that the rate of white male middle-age deaths is on the rise, as well. So when we consider health disparities and public health, it’s important to realize there’s one boat, one health commons, and every person in America is impacted by those social determinants of health beyond the healthcare system: clean air (ask a miner in West Virginia), clean water (ask your cousin in Flint, Michigan), good jobs (with health benefits – ask any worker without them), nutritious food (ask someone living in a food desert), social connections (ask an isolated senior), and in my growing appreciation, access to connectivity/broadband networks (ask anyone looking for a job  or a clinic for a lab test without a good smartphone data plan). In 2019, an emerging concern is how the growth in adoption of artificial intelligence and cognitive computing among health care organizations – particularly, insurance plans, providers, and pharma. AI can be used for good, to be sure. The promises of Big Data in health cover a wide range: hospitals anticipating and preventing inpatient readmissions; health plans deploying more effective population health programs; and research-based life science companies being more intelligent and efficient in finding cures. But AI also can mine data from sources beyond the medical claim that mashed together profile people in ways that can be used to bias business choices in the interest of cost-saving or simply-put, prejudice. We must guard against exacerbating health disparities with these sorts of AI applications in health and medical care. A recent U.S. District judge ruling against the Trump administration’s decision to add a citizenship question to the 2020 U.S . Census is another example of how institutions, and public ones at that, can try to mis-use data or mis-appropriate data. For an in-depth look into this phenomenon, see my report, Here’s Looking at You: How Personal Health Information is Getting Tracked and Used, written for the California Healthcare Foundation. Finally, read what U.S. doctors have to say about health disparities in JAMA. The top line for doctors lies in the concluding sentence: “Apart from the human and economic consequences affecting today’s adults and workforce, the health disadvantages faced by today’s children carry profound implications for tomorrow’s adults, the nation’s economy, and national security. Now the question is what US society is prepared to do about it.”  To this end, I am encouraged (immediate-term, anyway) by the growing understanding and embrace of the role of social determinants for health in America among both providers and health plans. Coming full circle to Dr. King, there’s a paragraph from MLK’s speech delivered at the Great March of Detroit that especially resonates on his special Day: “We are coming to see now, the psychiatrists are saying to us, that many of the strange things that happen in the subconscious, many of the inner conflicts, are rooted in hate. And so they are saying, ‘Love or perish.’ But Jesus told us this a long time ago. And I can still hear that voice crying through the vista of time, saying, ‘Love your enemies, bless them that curse you, pray for them that despitefully use you.’” Health Populi’s Hot Points:  I am a child of metro Detroit. As a very little girl, I lived through the Detroit Riots of 1967, a few days after which my father drove us through the fire-devastated neighborhoods of his friends and clients who lived and worked around 12th Street and Grand River. It was a visceral moment for me in my life, one of my earliest memories, seeing burned-out shops on pedestrian main streets. I remember still the smoky smell which my young lungs breathed in. I wondered why something like this happens. In a few years’ time, I was reading Martin Luther King’s book, Why We Can’t Wait; The Autobiography of Malcolm X, and Native Son by Richard Wright — still, one of my favorite books. In college, I delved deeply into urban economics and urban planning, soaking in Jane Jacobs’ seminal work, The Death and Life of Great American Cities, among other influential books on the syllabus.                 At the University of Michigan School of Public Health, I then learned to connect the dots between our environment, our socioeconomic status — especially the role of education — and health. Addressing health disparities is as much about access to health insurance as it is to access to good and well-priced food, safe schools, education, good jobs, and sound social policies about gun ownership and use. We must also attend to seeing that broadband and connectivity, and net neutrality for access to the online world, services, and communities, are guaranteed to all health citizens in America. These interrelationships are fundamental to public health thinking. Those of us whose work touches any aspect of health and health care must attend to public health and commit to reducing health disparities in America. A healthy populace is more productive across so many dimensions. As we continue the hard work to re-build the national economy and continue to expand affordable health care access, public health should and must be seen and used as a pillar for economic growth. This was a key call-to-action I raised at the conclusion of my book, HealthConsuming: From Health Consumer to Health Citizen, most Americans, having morphed into payors and consumers, see health care as a human or civil right. As health citizens, people in America would be covered by universal health insurance and more comprehensive data privacy protections. That’s the rights side of the civics ledger. On the responsibilities side, Americans must become more politically engaged, embracing their role as citizens and the blessings of the freedom to vote and engage in public policy in the commons. That’s what MLK would have wanted.             In my most recent book, Health Citizenship: how a virus opened hearts and minds, I am even more pointed based on what we’ve experienced during the public health crisis, the summer when George Floyd got more white people woke, and the pandemic economy hurting people of color more than white folks. Health citizenship has four pillars: health care as a civil right, digital citizenship and privacy rights of personal information, trust (in science, in each other), and a new social contract — which is love in the Age of the Coronavirus. My friends, it does seem dark right now at the convergence of so many crises — the pandemic, the economy, social and civil rights, and most recently a crisis of confidence in democracy. But as MLK, Jr., said in his book, All Labor Has Dignity…”I know, somehow, that only when it is dark enough can you see the stars.” This post was updated from previous versions that have run here on Health Populi to commemorate Martin Luther King, Jr.’s, birthday. 

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Our Homes as HealthQuarters – Finding Health and Well-Being at CES 2023

For over ten years, digital health technology has been a fast-growing area at the annual CES, the largest convention covering consumer electronics in the world.           When the meet-up convenes over 100,000 tech-folk in Las Vegas at the start of 2023, we’ll see even more health and self-care tools and services at #CES23 — along with new-new things displayed in aisles well outside of the physical space on the Las Vegas Convention Center map labeled “digital health” at this year’s CES in the North Hall.         Some context: my company has been a member of the Consumer Technology Association for many years, and I have attended CES more than a dozen times. Gary’s Book Club featured my HealthConsuming: From Health Consumer to Health Citizen at the 2020 CES. [FYI, “Gary” is Gary Shapiro….             Every year, CES features the “Best Of Innovations” in the many categories of products featured at the meeting, and this year’s 2023 digital health honorees span a wide range of applications including heart health, hearing, oral care, sleep, diabetes management, neurology, and other areas of health and medicine. As my advisory work with companies across the health/care ecosystem has increasingly shifted to omni-channel, home-based and retail sites, CES has emerged an important touch point for me every year to receive updates and check-in with key innovators that increasingly serve up tools underpinned with clinical evidence and enchanting design.           That’s what I’m looking for at #CES23. One way to deal with the scale and sheer physical experience of CES is to have a context for filtering the thousands of offerings, a sort of sensual overload. For me in 2023, that construct is the home as the hub or “`HealthQuarters” for Everyday People — not only athletes or digitally native (younger) consumers. So we can think about the home’s “HealthQuarters” by “room,” such as the bedroom (for sleep and healthy sex-lives), the bathroom (for weight and mood observed in the mirror, or the toilet as a collector of health data), the kitchen (for healthy food and cooking), and the overall home environment itself for air and water quality. For wonkier health care folks, you can consider these the “home determinants of health,” a subset of the big umbrella of social determinants or drivers of health. Start in the bedroom, with a heavy dose of sleep — a growing category at CES for several years. Over the past ten years, as a sleep-fan, I’ve tried out various beds, smartrings and sensors for the bed. At CES 2023, sleep is a major segment. Somalytics will feature a sleep mask to monitor REM and track eye movements. This technology and expertise has only been available in sleep centers, and now Somalytics is moving this capability to consumers at home.         Ergosportive, part of the Ergo-motion company, will show its bed designed for sleep and recovery targeted to athletes and fitness-oriented consumers. Its app, which also connects with Garmin devices, tracks sleep, health and recovery data which can be shared with coaches. Think about this product beyond elite athletes, for our kids’ healthy sport involvement and people participating in sports throughout the year. Heart health has become mainstream in digital health at CES, with wrist-tracking bands embedded various aspects of heart tracking, ear buds growing heart monitoring capabilities, and FDA-cleared blood pressure readings from the wrist from OMRON and Withings.           I have lauded OMRON’s “Going for Zero” long-term company vision to reduce strokes and heart attacks to “zero.” OMRON’s HeartGuide earned FDA clearance for its blood pressure monitor worn on the consumer’s wrist, featured here in Health Populi in 2018. At CES 2023, OMRON will announce the company’s expanding efforts for remote heart-health monitoring (RHM) and clinical evidence generated through its launch of RHM. Withings expanded remote patient monitoring earlier in 2022, and began to collaborate on clinical trial data connections between consumers and researchers. We can expect Withings to expand more of that clinical connectivity to people self-caring at home — details under embargo until January 3 — but suffice it to say they comport with my HealthQuarters concept for more evidence-based care at-home. Beyond the wrist, the ear has been getting more attention for digital health physical “real estate,” including hearing and heart applications among others. Some big retail health news in 2022 was the FDA’s finally enabling hearing aids to be sold direct-to-consumer — more on that important development here.           At CES 2023, we’ll see more hearing tech innovations like the CES honoree in the wearable tech category, Oticon. The company is offering a hearing device integrating deep neural network technology that offers “BrainHearing through the ear” in a customized hearing aid. You might not think about pharmaceutical companies showing off technology at the “Consumer” Electronics Show, but the pharma industry has had a growing presence at CES for the past few years. Last year, Abbott made a big splash with the company’s Board Chairman/CEO delivering a keynote addressing connected care. This year, Abbott will once again be quite present at the conference, receiving three 2023 CES honors for innovations for a pacemaker, pain alleviating technology, and a monkey pox PCR test. Abbott will be joined by pharma and life science peers Merck, talking about the human brain and data collaboration across industries; and, SK Biopharmaceuticals which developed glasses that can detect or predict seizures based on the wearer’s brain, body and heart functions, among others demonstrating that prescription drugs and digital therapeutics have joined the consumer’s personal health ecosystems at home and in the community.       Among many other developments, I’ll be digging into… The huge opportunity for leveraging digital twin technology in health and life science research, and this year Dassault Systems will detail the company’s offering for “virtual twins” in and beyond health/care applications. The challenge of healthy aging, led by AARP, a long-time participant in the annual CES conventions and this year launching the AgeTech Summit. Ad part of this effort, MITRE’s Engenuity program will be firmly focused on health equity, access, security, and quality of life for all health citizens — especially older people. Explorations into emergency medicine and health care futures will be led by the American College of Emergency Physicians (ACEP), part of the Digital Health Studio at CES 2023. In the explicitly non-digital health nor wearable tech areas of CES 2023, I’ll be exploring many aspects of our HealthQuarters beyond medical things — especially healthy eating and cooking (“the kitchen as health maker”) and clean environments for living well — namely clean air and clean water. In addition, the growing Internet of Things for healthy living grows annually at CES, and this year IoT will continue to grow mainstream muscles through voice technology, and home sensors for safety and security. Health Populi’s Hot Points:  As Kinsey Fabrizio, Senior VP at CTA, told U.S. News & World Report in a December 15th interview discussing the exhibitors, “They’re going to be showcasing some of the[se] solutions that were critical during the pandemic, and a lot of the solutions that have continued to change the way consumers live and behave.” Underpinning that behavior has been consumers’ personal digital transformations through the pandemic, one of those silver linings we can look to as a positive outcome for many people now empowered through consumer technology for many life-flows. Indeed, the COVID-19 public health crisis accelerated consumers’ embrace of digital tools for living, working, cooking, shopping, praying, playing, learning from, and exercising at home. We’ll see companies like Samsung increasingly connecting technology for good and healthy living throughout our “HealthQuarters,” even when not labelled as-such. Autos, too, will continue to build out safe and healthy functionality for mobility wellness and connectivity back to the home and person, as we’ve seen detailed at previous CES meet-ups. Stay tuned for my ongoing coverage of all-things-health during the first week of January 2023 via the Health Populi blog, my Twitter handle @HealthyThinker, and my LinkedIn channel at Jane Sarasohn-Kahn. In the meantime…welcome to your new HealthQuarters!

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Quick, Accessible, Inexpensive Health Care – A Retail Health Update from Amazon and Dollar General

Two announcements this week add important initiatives to patients’ growing choices that speak to their consumer-sides’ sense of value and personal healthcare cost-containment: Amazon launched RxPass, a generic medicines subscription service; and, Dollar General promoted its mobile health service powered by DocGo on demand for health visits, “right outside the store.”             These two programs come from outside of the legacy health care system of so-called incumbents — hospitals, health systems, health insurance — leveraging two brand-names beloved to many consumers for convenience, price transparency, and sheer cost. First, check out Amazon Pharmacy’s RxPass. Amazon announced the program in this press release today. Top-line, the announcement said that, “In addition to all the savings, convenience, and entertainment they already enjoy, Prime members can now receive all of their eligible generic medications for just $5 a month and have them delivered free to their door. Medications that treat more than 80 common conditions, such as high blood pressure, anxiety, and acid reflux, are included in the RxPass subscription.”         While Prime membership growth has begun to stall in 2023, the fastest-growing demographic during the pandemic was older people — most of whom consume maintenance medications for chronic conditions like heart disease (take statins, blood pressure meds), mental health management (see Zoloft generic in the graphic on the left), and respiratory conditions (note Singulair in the picture at the center). Patients receiving 90-day supply of drugs via mail order are already used to that delivery channel, so Amazon RxPass adds the lower-cost factor to the convenient delivery/ecommerce mode which consumers, younger and older alike, have come to expect.                   Now take a look at Dollar General’s expanding medical visit platform channeled by DocGo on demand. This brings a new riff or definition to the phrase “mobile health,” providing as the PR says, “quick, easy health visits. Right outside the store.” I wrote about Dollar General’s growing health care strategy in July 2021 here in Health Populi, and in December 2022 its project with the Consumer Healthcare Products Association to bolster health literacy for over-the-counter medicines. The trend to Dollar and Convenience Stores (C-Stores) to grow health care muscles and product aisles has been percolating for some years: I pointed out the growing retail health ecosystem in my book HealthConsuming, noting that, “Even convenience or ‘C-stores,’ which have a reputation for selling ‘Cokes and smokes,’ are  reinventing small footprint shops for health. 7-Eleven, Circle K, Wawa, are all responding to health-conscious consumers’ preferences for nutritious foods and on-the-go access.” Health Populi’s Hot Points:  Expect incumbent health care stakeholders — hospitals, health systems, health plans — to be developing their own strategies addressing the evolving DTC consumer retail health ecosystem. Take Optum, which this week launched the Price Edge tool to help steer patients to the “lowest price generic medicines” according to the program’s press release. The price-comparison tool exclusively focused on generic drugs will be available to Optum Rx members. “Compared to most direct-to-consumer prescription drug prices, Optum Rx already offers a lower price nearly 90% of the time and Price Edge ensures a competitive consumer price on generic drugs with every transaction. Price Edge scans available prices and automatically provides the lowest available pricing to the member. If there is a lower cost to the member outside of their insurance benefit, Price Edge automatically applies that price. Unlike other direct-to-consumer pharmacy solutions or cash market pricing, transactions initiated through Price Edge count toward the member’s deductible and out-of-pocket maximum. Plan sponsors also do not incur additional administrative fees for implementing Price Edge and their members automatically access the tool within their plan at no cost. Additionally, by capturing all transactions within the member benefit, Price Edge maintains continuity of safety protocols and safeguards against contraindications between medications,” Optum explains.                   In the meantime, Dollar General’s over-arching message asks health consumers, “Why pay drug store prices?” The DG Wellbeing banner and branding will speak to many value-conscious, financially stressed patient-consumers managing tight household budgets and feeling dis-empowered facing the price of a dozen eggs and other family-fiscal pressures in 2023. We’ll observe how patients-as-consumers’ behaviors might change and shift to the newer on-ramps and front-doors to health care services and products. Amazon and Dollar General updates give us two more signposts in the evolving (read: growing) retail health landscape and choice architecture for patients paying out-of-pocket for healthcare.

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The American Hospital Association Looks at Retail and Tech Health Care Disruptors

Ever since Clayton Christensen explained the concept of disruptive innovation in 1995, health care became one of the poster children emblematic of an industry ripe for disruption. Nearly 30 years later, disrupting health care continues to be a theme which, in 2023, seems open for those slow-moving tectonic driving forces to finally re-form and re-imagine health care delivery. So in today’s Health Populi we turn to a new report, Health Care Disruption 2023 Outlook, part of AHA’s “The Buzz” market scan initiative. The American Hospital Association is taking disruption seriously right here, right now, as the U.S. hospital sector is facing major challenges on all fronts: staffing (especially nursing and more broadly, clinician burnout), supply chain, financial stressors, demographics, and cross-industry politics vis-à-vis pharma and health insurance.             The report explores the healthcare market moves for seven major players in retail and tech including Amazon, Apple, CVS Health, Google, UnitedHealth Group (exploring both Optum and UnitedHealthcare), Walgreens Boots Alliance, and Walmart. The top-line theme of the report is that, “The $260 billion primary care market is dominated by traditional providers in a fee-for-service arrangement, but that is changing rapidly,” the report begins. “By 2030, nontraditional players could own as much as 30% of the primary care market.” The report then provides one-page analyses addressing each of the seven companies profiled, describing their respective approaches to the health care ecosystem. In brief, in alphabetical order…. Amazon has been investing to expand primary care (virtual and in-person), diagnostics and therapeutics, pharmacy, disease management, and leveraging AWS for data-driven tools and analytics. Apple won’t be one of the contestants in the retail health/primary care battle royale (as I discussed here in Health Populi over the week of 25th July 2022), but instead will focus on using platforms of Apple Watch and the iPhone to partner across the health care ecosystem and support people through healthy living and chronic disease management. CVS Health continues its vertical integration with Aetna, primary care (again, virtual and in-person), home care, and retail health via the pharmacy storefront and omnichannel platforms. Google (Alphabet) will be all about tech-driven health care, leveraging AI for more personalized health care which will also support research and development. In addition, like Amazon’s AWS, Google will be partnering via the Google Cloud with health care providers, pharma, and other innovators to accelerate health care transformation and innovation. UnitedHealth Group has many moving parts between Optum and UnitedHealthcare, expanding services from primary care and mental/behavioral health to care coordination and virtual care. Optum’s merger with Change Healthcare expands the organization’s data and analytics capabilities, too. And the company has acquired thousands of physician practices, with now more than 70,000 employed or aligned doctors in over 2,200 sites as of 2023 — more physicians than Kaiser or even the VA have on their staff. Walgreens has grown its primary care footprint through the VillageMD connection, now owning 2/3 of the company and expanding PCP practices to over 25 U.S. markets by 2025 and planning for 1,000 by 2027. Like CVS Health, Walgreens is also expanding home care services and post-acute care, and specialty pharma to complement pharmacy operations. Walmart has long committed to health care, leveraging pharmacy as a “front door to primary care,” AHA describes. The largest retailer in the U.S. is expanding virtual care and telehealth, and building long-term partnerships across the health care ecosystem — including one with UnitedHealth Group over a ten-year agreement. Together, the AHA sees these seven companies potentially capable of developing and offering innovative care models that could “significantly alter” the health care landscape, enable the shift to value-based care models, and grow alternative care sites and channels of care.               Health Populi’s Hot Points:  In concluding the report, AHA poses four questions providers should consider in light of the seven health care disruptors’ moves: Is there an omnichannel presence that supports consumers’ demands for access, convenience, pricing and transparency? Is there an opportunity to partner with one of the primary care transformers? Can the provider leverage the earned trust and relationships with existing patients to grow consumer-facing services? Can the provider partner with tech firms on data and research projects to improve care?             What underpins and inspires the seven “new” entrants to disrupt health care is consumer expectations. In 2016, I called out that most patients-as-health-consumers looked at Amazon as a model for health care experience to emulate well before Amazon acquired PillPack or invested in the industry as a major corporate vertical market strategy. Now that patients feel increasingly like health care payors — facing high-deductibles and out-of-pocket costs — all health care looks/feels like retail. And as such, the seven companies featured in AHA’s disruptors report illustrate the kinds of benefits these kinds of companies can bring to bear to health consumers’ experiences. Beyond the seven in this report, don’t count out Microsoft, Salesforce and Samsung on the technology sector side, and retailers Dollar General, Target, and grocery stores like Kroger out of the mix of disruptors-for-better-patient-experience.

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Food-as-Medicine Update: How SNAP Members Face Greater Chronic Illness and a “Hunger Cliff”

The pandemic worsened food insecurity for many people in the U.S., putting more people at risk for not only hunger but for chronic diseases that can be managed with access to nutritious, fresh food. In Helping SNAP Consumers During Economic Headwinds from Numerator, we get a current read on food security, the SNAP program, and the challenges of chronic health management that are intimately tied. To set some context on this current challenge to peoples’ health, the U.S. is facing the official end of the pandemic emergency on May 11, 2023. At that point, support for government-sponsored programs that have supported American health citizens’ well-being since the emergency of COVID-19. This included expansion of SNAP and nutrition benefits, among many other services. Exacerbating food insecurity in America, note that food price inflation rose 9.5% in February 2023 versus February 2022; prices will increase by 7.9% in 2023, the U.S. Department of Agriculture expects. People living in low-income households are facing growing stress and insecurity when it comes to food, resulting in a “hunger cliff.” It’s a “cliff,” explained Ellen Vollinger of the Food Research and Action Center, “because this is a very abrupt change in what people are going to have in their food budget,” affecting millions of people in the U.S.             With these data points in mind, we can dig into Numerator’s look into SNAP consumers’ home economics. The first chart shown here from the report profiles enrollees in SNAP programs, the Supplementary Nutrition Assistance Program which is part of the USDA. Numerator, a consumer market research company, profiled SNAP recipients at the end of 2022, finding that 61% of the enrollees were in the bottom 30th percentile of income in America. Nearly one in two SNAP households had children versus 28% of non-SNAP homes. And SNAP households were twice as likely to be Black/African-American or Hispanic/Latino in their race/ethnicity compared with non-SNAP households.             This study looked into the “headwinds” facing SNAP consumers’ home economics, recognizing that the COVID-19 stimulus funds helped to buoy food-insecure householders for many months However, as these funds ran down and out, the inflationary era kicked in the U.S. economy. SNAP households are now more likely to be “overwhelmed” with financial burdens, Numerator observed. These folks heavily over-index with being struggling households, the study found, compared with other U.S. families. One in four are unable to buy enough food to feed their family, and most have low confidence in the economy improving in the next three months. There are four themes for SNAP benefits and enrollees in 2023, explained in the second chart here: brands will need to understand how SNAP recipients are adjusting their shopping baskets, looking for value and lower prices; SNAP consumers are buying more private label products (which are lower-priced); health and wellness are key to SNAP recipients purchasing behaviors, challenged by time constraints in their daily lives; and, brands need to segment consumers looking, in part, at their occupations — heavily indexed toward healthcare and homecare, housekeeping, childcare/daycare, transportation, and other work categories.           Keep in mind these occupational types when considering SNAP enrollees health and wellness goals and challenges. These people are nearly 4 times as likely to be disabled than consumers not enrolled in SNAP benefits: these conditions include respiratory health (COPD, asthma and bronchitis), back pain, and migraines, among other issues. We know folks dealing with one social determinant risk tend to have more than one risk, and in this instance it’s a greater burden of heath expenses over the course of a year. =           These chronic condition management challenges are worsened, risk-wise, due to the fact that SNAP enrollees tend to be time-challenged, and of course, financially insecure as well as food-insecure. Fifty0six percent of these consumers are less likely to not be actively managing their health. One factor Numerator identified that may constrain peoples’ ability to self-care is that SNAP recipients are time-strapped as they are two times more likely to be a caregiver for over 9 hours a week. One in three SNAP enrollees shops at least twice a week as a caregiver, and one-third have the person they care for living in their home (1.2x more likely than non-SNAP recipients).           Health Populi’s Hot Points: “Supply and demand for basic human needs has severe implications,” a brief co-sponsored by Quest Diagnostics and Pack Health calls out. “Just eat healthier” implores the essay on why diet improvement as a chronic condition management strategy has not been effective for people experiencing food insecurity. The pandemic exacerbated peoples’ food insecurity in the U.S., with demand far outstripped the supply of food provided at food banks. And food insecurity raises peoples’ risks for chronic conditions, the straight-line graph illustrates as a direct correlation. As Pack Health and Quest note, “the lack of resources isn’t just about the food itself. Those who are food insecure are also more likely to be affected by other social determinants that contribute to worsened health outcomes.” To address the food security risk for chronic health conditions, Pack Health couples grocery and meal delivery services with nutrition education and digital coaching. Think: telehealth meats meals-on-wheels meets nutrition education.  

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Wellness in 2023 Is About Connections, Mental Health and Science – Global Wellness Summit’s 2023 Trends

Consumers’ wellness life-flows and demands in 2023 will go well beyond exercise resolutions, eating more greens, and intermittent fasting as a foodstyle. It’s time for us to get the annual update on health consumers from the multi-faceted team who curated the Global Wellness Summit’s annual report on The Future of Wellness 2023 Trends.                   In this year’s look into wellness for the next few years, we see that health-oriented consumers are seeking solutions for dealing with loneliness and mental health, weight and hydration, travel-as-medicine as health destinations, and — not surprisingly — technology-driven approaches to biohacking, beauty, and what the report calls “multisensory integration” (explained below). Two of the 12 trends deal with business and the workplace, illustrating the reality of the blur working people now have between their “9 to 5 lives” and home/social lives. And one trend deals with wellness + governments: the case for coming together, which I’m keen on with my lens on health citizenship.               Even in a tough economy, consumers have made wellness a top priority, increasing personal spending on different health-and-wellbeing bets based on personal values and preferences. It’s a marketspace that the Global Wellness Institute estimated worth $4.4 trillion in 2020, as the bubble chart illustrates. GWI’s typology of wellness market segments covers a comprehensive landscape, in order of size: Personal care and beauty Healthy eating, nutrition and weight loss Physical activity Wellness tourism Traditional and complementary medicine Public health, prevention, and personalized medicine (specific to wellness applications) Wellness real estate, and Mental wellness. Were GWI to re-calibrate this landscape today, post-pandemic, I would guestimate that the mental wellness bubble would be much larger, with personal care and beauty definitely bolstered in and in the wake of the pandemic. What’s really new in the post-COVID consumer is that people are more science-oriented, more reflective, and many (especially younger health citizens) keen on “each other and the planet.” Think climate change, sustainability, and ESG as driving forces inspiring consumers to take on new and silo-busting wellness behaviors. I highly recommend that you download and read the entire report which will expand your mindset about where and how wellness can be experienced, made, and shared. Here, I’ll weave three cross-currents that I’ll be incorporating in my scenario planning and other work this year (and ongoing)… Making connections.  Several trends embed peoples’ need to gather, to have human touch, to commiserate, to join and belong. Beth McGroarty speaks eloquently about the loneliness epidemic, which continues to plague some of us in different ways: still viscerally remembering or being conscious of physical distancing, for example, or avoiding going to the gym continuing our online fitness gatherings. “The future of wellness is a move from lonely to social self-care,” Beth writes, “buying to belonging, URL to IRL, ego to empathy, Goop to group.” This is reflected in how many people are choosing to travel and experience new places, head back to work, and look to governments for support in “coming together.” Managing the work/life blur with balance and joy.  While employers (particularly larger companies) have allocated serious resources for wellness programs, what that meant pre-pandemic feels quite different to workers-as-health-consumers in the wake of COVID. Certainly mental health and financial wellness are two pillars of overall wellbeing for which employees seek support from employers. But int he words of Skyler Hubier and Cecelia Girr, “workplace wellness finally starts to mean something.” A serious and challenging aspect of this separate from the pandemic is what healthcare and well-being looks like in a post-Dobbs world in the U.S. Women’s health, from growing fem-tech investment to family-friendly benefits will be key to attracting and retaining talent. Hybrid working from home and in the office IRL has created a blur in working peoples’ lives which without attention to guardrails, balance, joy and human connections, is a recipe for burnout and so-called quiet quitting.             Being Missourian in spirit and intent: seeking the science and the evidence.  Whether looking at biotech beauty and what “clean” really means, effectively dealing with obesity, or biohacking our biology, wellness-engaged health citizens are not interesting in the shiny new thing without data backing up claims. Consumers continue to seek greater transparency and trusted voices to inform their decisions. The 2023 Edelman Trust Barometer found that scientists are the most-trusted institutional leader this year, ranked above all other leader types. This is consistent with other studies from the past few years, as consumers’ faith in governments and media has dramatically eroded. Note that Edelman also re-asserted its discovery of the past couple of years that peoples’ employers are also relatively trusted sources of truth and facts — lending additional credence to the Global Wellness Summit emphasis on workplace wellness in this year’s trend report.                     Health Populi’s Hot Points:  In their 2023 read of The Rise of the Conscious Shopper, Ipsos paints a profile of consumers adopting a keener value orientation, recommending that organizations design and offer products and services that align with peoples’ demands to support future goals that benefit their physical and/or mental health. People look at health well beyond their health care system, and this is particularly true for younger people who have taken to virtual care/telehealth services more readily and consistently than older patients. This is especially useful for the long-underserved and -supplied mental health and therapy market, which is persisting more consistently post-COVID and the public health emergency that telehealth for primary and urgent care. As Ipsos reminds us and GWS’s report reinforces, more people want to feel more empowered when it comes to health across all dimensions — physical, mental, financial, spiritual.

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Record Numbers of People in the U.S. Putting Off Medical Care Due to Cost – A New “Pink Tax” on Women?

More people in the U.S. than ever have put off medical care due to cost, according to Gallup’s latest poll of patients in America.             Gallup conducted the annual Health and Healthcare poll U.S. adults in November and December 2022. This was the highest level of self-rationing care due to cost the pollster has found since its inaugural study on the topic in 2001. This was also the most dramatic year-on-year increase of postponing treatment due to cost in the study’s history.             Note the substantial difference in women avoiding care for a serious medical condition due to cost compared with men: there is a 12-percentage point difference, with 32% of women avoiding care due to cost, compared with 20% of men. Furthermore, note that the slope of the curve for women was steeper than among men.             The point that more patients delayed treatment due to cost is especially concerning given that the delays were more common among patients dealing with a very or somewhat serious condition versus those health consumers facing less serious conditions — the green line here represents patients facing serious conditions, with 27% of them delaying care due to costs, versus 11% of people without serious conditions delaying care. Health Populi’s Hot Points:  Gallup concluded that, “With high inflation creating moderate to severe hardship for a majority of Americans in the second half of 2022, their reports of delaying medical care in general due to cost — as well as delaying care for a serious condition — rose sharply to new highs. Young adults, those in lower-income households and women were especially likely to say they or a family member had put off medical care.” In the COVID-19 pandemic, it was women who were hit financially harder than men in the U.S. (a different fiscal impact than that felt by men in the 2008-9 Great Recession).                   Is this a new riff on the so-called “Pink Tax?” If so, it goes well beyond the difference in retail price for a pink razor versus a blue or black one. This round of Gallup’s research suggests that there’s another lens on “financial toxicity” in health care beyond the usual context of high-priced specialty drugs (say, for dealing with oncology/cancer). I discussed that here in Health Populi last year with respect to medical debt and FICO scores. Beyond specialty drug price burdens, many U.S. patients now face general financial toxicity for health care costs, compelling patients to delay care for serious conditions (think: cancer, heart surgery, and other acute medical problems where timeliness can be the difference between surviving, and living well, versus increased mortality and reduced quality of life-years. Expect women to try and find hacks and strategies to deal with this medical-fiscal stress. “Self-care” will take on many meanings and product/service iterations that may be outside of mainstream FDA-regulated and commercially reimbursed care. Financial service companies are addressing some of this financial challenge. The health care industry has the opportunity to collaborate across industries to, especially, craft services that women can access to support their care especially for high-cost, serious diagnoses. Furthermore, public policies like those recommended in the Marshall Plan for Moms would help mitigate women’s risks for self-rationing medical care.

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The Reputation of Pharma Among U.S. Consumers Is Tied More to Pricing Than to Innovation

In the U.S., price and the cost of medicines is tied to how people feel about the pharma industry, evidenced in the Global Pharma Study 2023 from Caliber. Caliber, a reputation and corporate strategy consultancy, fielded survey research among over 17,000 health consumers including U.S. adults between 18 and 75 years of age as well as health citizens living in Brazil, China, France, Germany, Japan, and the UK.                 Caliber assessed the reputation of 16 industries, globally, finding that pharma ranked 10th among the 16, just below automotive and just above chemicals (and well above the 16th last industry, oil and gas). As in other studies we’ve discussed here in Health Populi, consumers’ favorite industries continued to be consumer goods (non-food), retail (food), retail (general), electronics, and food and beverage.               Diving into pharma, the top three issues consumers point to for building trust were drug safety, “health over profits,” and pricing, globally. In the U.S., though, price trump everything for trust — including safety and innovation which ranked second in a virtual tie. A couple of other differences between U.S. health citizens and the global profile: U.S. consumers were less likely to call out humanitarian access to medicines compared with the rest of the world, and U.S. consumers were more likely to identify fair marketing and sales practices as important for trust-building.                   Trust is a precursor requirement for health engagement, so this four-matrix chart emphasizes the importance of integrity, authenticity, inspiration, and relevance for trust-building. While innovation and leadership rank high on attributes, they are less important to global consumers than the integrity-authenticity-relevance factors. The red quadrant, up and to the right, is the happy place where all organizations would like to be: that is, with high scores on both attributes and consumers’ importance. Caliber asserts in the title of the chart that, “the [pharma] industry needs to shift focus to get people to advocate on its behalf.”             Health Populi’s Hot Points: Patients’ financial experience with health care is now integral to their overall consumer experience. This has been the case since patients filling prescriptions at the pharmacy at point-of-purchase began to face growing copayments and coinsurance shares for branded prescription drugs many years ago. But the sticker shock for certain branded drugs off-formulary has moved this issue to the top of U.S. voters’ minds. Over one in three people in the U.S. point to prescription drugs as the highest spend category in U.S. health care, the graphic part of the December 2022 Kaiser Family Foundation Health Tracking Poll. But prescription drugs are personal: they are purchased locally or via mail order, have “my” name on their labels, and in terms of “my” out-of-pocket costs, prices seem more transparent and immediate (and often surprisingly higher than expected)             Timing-wise, it behooves me to include a link to President Biden’s State of the Union remarks delivered last night; in the SOTU, President Biden spoke to the issue of prescription drug prices in part discussing the patient-facing cost of insulin for diabetes: “You know, we pay more for prescription drugs than any major country on Earth. For example, one in ten Americans has diabetes. Every day, millions need insulin to control their diabetes so they can stay alive. Insulin has been around for 100 years. It costs drug companies just $10 a vial to make. But, Big Pharma has been unfairly charging people hundreds of dollars – and making record profits. Not anymore. We capped the cost of insulin at $35 a month for seniors on Medicare. But there are millions of other Americans who are not on Medicare, including 200,000 young people with Type I diabetes who need insulin to save their lives. Let’s finish the job this time. Let’s cap the cost of insulin at $35 a month for every American who needs it,” and so on. The Caliber report’s recommendations on inspiring patients and other people to advocate on their behalf — as well as find a place of “relevance” in peoples’ lives — precisely responds to the Kaiser Family Foundation poll finding.

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Growing DTC for Health Beyond the Rx – the New Health/Care at Home

As our homes and health care services continue to converge, we can see signposts of direct-to-consumer strategies from the pillbox (where DTC is a mature thing) to clinical care in peoples’ hands (and on their preferred technology platforms). Some examples this week make this point, which taken together demonstrate the portfolio of ways more people – as health consumers and caregivers – can engage in their health, well-being, and clinical care.             Start with Best Buy’s announcement that they will collaborate with the health system Atrium Health to bolster hospital-to-home effectiveness and activation between hospitals and patients. You know Best Buy for its consumer electronic retail chops, starting up Best Buy Health several years ago as a key pillar for the company’s strategic long term plans. Enter Atrium Health into this mix: the hospital system has had a successful entry into hospital-at-home care, and with Best Buy as partner, will grow the consumer-digital-health front-end capabilities through a trusted retail brand’s Geek Squad expertise. I can’t say it better than Deborah Di Sanzo, President of Best Buy Health, did in the press release: “We knew Atrium Health was the right partner to help tackle the unique challenges within the care at home experience,” said Deborah Di Sanzo, president of Best Buy Health. “We’re excited to leverage our expertise in omnichannel, supply chain, Caring Center support and services, in-home support and our ability to connect patients and providers through Current Health’s care at home platform. Those strengths, combined with Atrium Health’s extensive clinical expertise and deep experience leading in virtual care, will help us improve and enable care in the home for everyone.” Now ad in prescription drugs which is the mature category of DTC in healthcare —  a unique aspect of American medicine as the only country in the world, except for New Zealand, which permits direct-to-consumer pharmaceutical advertising. This week, Teva Pharmaceuticals launched a campaign focused on caregivers — who are among the largest unpaid workforce collectives in the U.S. (For more on this economic and personal challenge, see the good work of ARCHANGELS, led by Alexandra Drane). As actor John Rhys-Davies (whom you have loved in Indiana Jones and Lord of the Rings franchises) attests, “Love doesn’t take a break” when you’re a caregiver. Rhys-Davies knows this so well, speaking out of his experience in caring for his wife until she succumbed to Alzheimer’s disease in 2010. Here, Teva collaborated with the agency VCCP London to raise our awareness of and appreciation for caregivers….baking in the empathy and personal story of Rhys-Davies. Well done, Teva.             On a different self-care front, check out this week’s news that WW (once known as Weight Watchers) acquired Sequence (aka Weekend Health). This acquisition grows WW’s telehealth capabilities, as Sequence built a subscription virtual care platform serving chronic weight management, including the use of GLP-1 prescription drugs. The platform enables patients and clinicians to collaborate in ongoing care and communication to support the long journey of behavior change. As of February 2023, Sequence was serving about 24,000 consumers. There’s more on Sequence here. A concurrent news story in the weight management space is the fast-growing prescribing by clinicians and adopting by consumers of drugs in the weight-loss category, the GLP-1 agonists. If you watch TV or stream radio, there’s no doubt you’ve heard some of the DTC ads for drugs in this group such as Rybelsus, Ozempic and Trulicity (currently three of the top ten DTC Rx spends). Weight-loss has been a top-self-care area for health consumers since the beginning of time, so watch this space closely. (Here’s a salient essay on the “bizarre Americanness” of DTC Rx spending from Vox if you want to know more).                   Add into this mix CHPA’s launch of the Health in Hand app, enabling consumers to access a trustworthy resource for comparing over-the-counter medicines, vitamins and supplements, and digital health devices. Supported by the Consumer Healthcare Products Association CHPA Educational Foundation, HealthinHand.org is designed for greater personalization, including new sections on My Self-Care and Healthy Living. There is updated support for people to hone in on specific diet/food styles, stage of life, and lifestyle choices.                     Health Populi’s Hot Points:  These are but four examples, in real-time, of the evolving home and self-care phenomenon accelerating in U.S. health care. There are many drivers accelerating this, among them peoples’ growing financial skin-in-the-healthcare game through high-deductibles and more out-of-pocket, more transparent costs borne by families. The current financial stress families feel bolsters peoples’ commitment to more care-in-hand and DIY care flows at home. Furthermore, younger people have shown fast-adoption of digital health techs, and lack of interest in making a permanent commitment to a primary care medical home. As the recent ATA conference chanted, #TelehealthIsHealth for more people, across generations, incomes and ethnic backgrounds. This is a major focus of my work these days in the U.S. and Europe. Keep staying tuned to the Health Populi blog as I continue to grow and learn more in the field on our home as site of care.

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Medscape Diagnoses Worsening Burnout and Depression Among U.S. Physicians

In the organization’s annual study into physicians’ wellbeing, Medscape has diagnosed worsening burnout and depression among America’s doctors.               Over one-half of U.S. physicians say they are burned out or depressed, the chart from the U.S. Physician Burnout & Depression Report for 2023 calls out. “I cry but not one cares,” is one of the represented color comments provided by one of the physicians included in the survey of 9,175 physicians polled online between June and October 2022. The study covered 29 specialties, finding most burned out physicians worked in emergency medicine (65% saying they were burned out), internal medicine (60%), pediatrics (59%), OB/GYN (58%), infectious disease (58%), family medicine (57%), and neurology, critical care, and anaesthesiology (all at 55%). It is safe to generalize that most physicians felt burned out by late 2022: burn out impacted physicians in public health and prevention, pathology, cardiology, nephrology and other specialties but still hit at least 37% of practicing doctors in those fields.               Nearly two-thirds of female physicians felt burned out compared with 46% of males, the second chart shows. Other key statistics in this study were that: 30% of doctors said they felt burned out for at least 2 years Physicians feel burnout across practice settings, from outpatient clinic and ambulatory care to hospital-based sites Only 13% of physicians have sought professional help to reduce their burnout, with another 47% saying they would consider seeking support. But only 45% of doctors said their workplaces offered programs addressing physicians. So why haven’t more doctors sought help for burnout or depression? One in two doctors said it was because “depression says something negative about me” (51%).             What contributed most to burnout, physicians said, were too many bureaucratic tasks (61%), lack of respect from coworkers (38%), too many workhours (37%), and insufficient compensation (34%). Key factors contributing to depression was first burnout (see previous paragraph!, for 64% of the physicians), world events (43%), and simply put, “being a physician.” Physicians cope first and foremost through exercise and physical activity (for 50% of people), talking with family or friends (43%), sleeping (41%), spending time alone (40%), listening to music (37%), and eating junk food (32%). 22% of the doctors said they drank alcohol to address burnout, with the same percentage meditating.           Unsurprisingly and sadly, two-thirds of physicians said burnout had a negative effect on relationships. And that impact goes beyond romantic attachments: one in two doctors said that depression affected their patient relationships in several ways: become easily exasperated, being less careful when taking patient notes, expressing frustration, and making “uncharacteristic” errors.               Heath Populi’s Hot Points:  When asked why they haven’t yet sought help for burnout or depression, one-half of the doctors believe that “depression says something negative about me.” In addition, 42% worried that people would think less of their professional abilities, closely followed by concerns that the medical board or their employer would find out about the mental health issue or think less of them as a result of knowing. “I cry but no one cares” coins the desperation too many physicians feel when it comes to their personal states of burnout and depression. Staying closeted about their mental health — due to concerns about professional or employers’ opinions — exacerbates the problem in terms of seeking support and sustaining the stigma that is too-often associated with being open about mental health concerns.             Medscape has been tracking U.S. physicians’ states of burnout and depression for many years. In 2023, the study asked how much COVID-19 affected peoples’ work-life happiness in the past year, a new factor that is also impacting clinicians’ well-being beyond bureaucracy, lack of autonomy, and pay, is indeed COVID-19. Four in 5 physicians believe COVID-19 negatively impacted their work-life happiness, with over one-third believe it has been a “significant” impact on happiness. From the early days of the pandemic in 2020, I pointed to two toxic side effects of the coronavirus beyond the virus itself: those were financial stress and mental health impacts. Here in our precious physician human capital, we see that quite clearly re-shaping clinicians’ hearts and minds in negative ways. We turn to the north star of the Quintuple Aim to remind us of what’s important about re-forming health care: improving health outcomes, delivering a better experience, lowering per-patient costs, addressing health equity and the fifth pillar: bolstering the well-being of clinicians. Medscape reminds us once again that physicians are in pain.

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Consumers Continue to Lean Into Digital Services: Beyond Tech and Hardware at #CES2023

While CTA forecasts a sobering consumer technology revenue picture for 2023, one of the few bright spots is health and fitness technology services, expected to increase by 9 percent in 2023.             For the forecast, CTA looked at various spending categories, including gaming, automotive and transportation tech, video and audio streaming, consumer electronics (like big-screen TVs), and fitness and health devices. The chart illustrates that consumers’ spending on software and services is expected to hold steady in 2023, still above pre-pandemic levels.             On 3 January, in the annual #CES update of Technology Trends to Watch, Steve Koenig, CTA’s VP of Research, reviewed the major themes with media and industry analyst folks (of which Health Populi is one). In 2023, Steve advised us to keep our eyes on six key trends: Enterprise tech Metaverse and Web 3.0 (which is “closer than we think,” Steve advised) Transportation and mobility Health technology Sustainability, and, Gaming and services. Health and drivers of wellbeing cross these six trends, and the plethora of services quantified in the on-demand segmentation revealed in the first chart.                   Consider our basic human needs, organized in my take on Maslow’s Hierarchy (with Wi-Fi). Take the most popular on-demand service in CTA’s research, grocery delivery. This was a literal life-saver for many people living at/working from/learning from/cooking at home during the pandemic, during and after lockdown phases, depending on where you lived and what your risk-tolerance was for being out-and-about. Sourcing food is at the base of our basic needs, and it appears that peoples’ demand for grocery delivery services is a changed behavior for over one-half of U.S. consumers post-pandemic. Food delivery follows this pattern as well for those folks who don’t want to scratch-cook. Next think about e-commerce: so many health consumers and patients depended on delivery of prescription drugs, over-the-counter medicines, supplements, and durable medical supplies to self-care at home. More consumers purchased digital health apps and home monitoring technology, as well, especially from Amazon and Best Buy which persisted in health-tech commerce and weathered economic challenges to-date. Finally cast your eyes to the health/wellness/fitness line item in the chart: 4 in 10 consumers were using on-demand health services (read: telehealth, virtual care, tele-therapy) more after the pandemic.                     Steve identified three segments of the new “home health hub” (a concept I detailed in my 2020 book, Health Citizenship): Telehealth, including remote monitoring as well as “access to doctors,” in his words Digital therapeutics, “new ways to manage health conditions;” and, Fitness tech. covering connected exercise and sports equipment building out the home gym experience. As examples at #CES2023, Steve talked about Essence Group’s Care@Home remote patient monitoring solution (which includes fall detection, a key application for safe aging at home), Abbott’s Proclaim Plus connected health device for spinal cord stimulation, and SK’s Zero Glasses for tracking neurological health (e.g., seizures), the latter two 2023 CES innovation honorees and Care@Home honored by CES in 2022. Three “new frontiers” in health-tech innovation were also covered — including on-demand networks (a la virtual care and online pharmacies), mental well-being (for stress relief, anxiety management, and depression monitoring), and virtual reality (VR, ranging from fitness to prescribed, evidence-based therapeutic treatments to address, say, pain and PTSD). Speaking of VR…Steve concluded the trends summary with a discussion on gaming and services, calling out a relatively bullish projection on consumer spending for services versus hardware. And what segments fall within that software and service category? Fitness and digital therapeutics, holding firm in consumers’ spending for 2023. Read more on what we’re seeing at #CES2023 here.

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Your Home as Clinical Lab: Withings Brings “Your Urine, Your Self” to #CES2023

We’ve all been morphing our homes into our personal HealthQuarters since the start of the coronavirus era. Millions of global health citizens have taken to telehealth who never used a health care “digital front door” before. Other patients adopted remote health monitoring to avoid perennial visits to doctors for managing chronic conditions like diabetes or heart disease. From the kitchen to the bedroom, our homes have become our health hubs. And now, to the bathroom and specifically, the toilet. Withings, maker of my personally favorite connected weight scale, announced U-Scan, a direct-to-consumer lab test platform that analyzes our urine from the POT – the point-of-toilet.                 I’m not being cheeky (sorry again, just too tempted) here — I’ve extolled the promise and virtues of our bathrooms as health destinations for many years, meeting up with tech and home innovators at CES over the past decade+, and keeping track of toilet innovations especially emerging from Asia. In the U-Scan launch press release, Withings describes the innovation as a “breakthrough in-home biomarker analysis platform that hygienically sits within any toilet bowl.” Withings’ research found that we urinate about seven times a day, but only test our urine, on average, once a year. Thus the program, “unlocks the wealth of health data in daily urine,” the press release notes.             The product earned honors for a prestigious 2023 CES Innovation Award, recognized by  reviewers as a front-runner in digital health tech at this year’s conference. Withings has received similar kudos at previous CES shows: last year, for the Body Scan weight scale (recognized by TIME magazine as one of the best inventions of the year), and back in 2015 for the Activité  watch and the Home HD camera embedded with environmental sensors. In 2022, Withings had seen over 1 million new devices installed.           This year, U-Scan gets even more intimate than that Home HD camera did, entering the bathroom of the home. In this “new era of urinalysis,” U-Scan offers a hands-free urine lab enabled through a reader and cartridge that can be installed in any home toilet — see it here in the photo at the front of the bowl. At launch, there are two clinical applications available: Nutri Balance addressing metabolic nutrition and hydration health, and Cycle Sync for women’s monthly cycle tracking. It’s “Easy as 1, 2 Pee,” Withings asserts in the press release. Once the consumer urinates in the toilet, the U-scan reader funnels the urine through the pump which begins the sample’s “fluidic journey.” The sample is tested in a pod inside the device, able to distinguish between users. Once analyzed, the resulting data are transmitted via Wi-Fi to the Withings app for the user’s health tracking. The app also delivers actionable advice — for diet, exercise, ovulation prediction, and other metrics. Some important features to note that will be important to health consumers: The system has a battery life of 3 months The platform incorporates Privacy-by-Design principles (which I explain here in Health Populi) The system will offer other clinical applications via cartridge innovations in the future The launch will be sometime in the second quarter of 2023 beginning in Europe; the U.S. launch date to be determined based on FDA clearance timing The European launch price will be €499 (about $530 at today’s Euro exchange rate to $US) with the U-Scan reader and one cartridge for 3 months of testing included; additional cartridges will be offered by subscription or one-off purchase. Learn more from the FAQ and feature details on the U-Scan website. And check out this video to hear more about the evolution of Withings’ connected health products and the clinical background on the U-Scan platform. Health Populi’s Hot Points: Meet Professor Marie Courbebaisse, a nephrologist with the Georges Pompidou European Hospital in Paris.                 The doctor is collaborating with Withings on research into kidney stone monitoring and management by consumers. She tells us in the video, “Being able to monitor specific urine biomarkers regularly and easily at home is a breakthrough innovation that opens exciting fields for nephrology research and patient outcomes. People suffering from lithiasis will be able to better self-monitor their condition and limit the occurrence of relapses.” Prof. Courbebaisse recognizes that, “Everyday, we learn more about how technology can improve outcomes.”                     Our homes are morphing into our personal HealthQuarters for bolstering our well-being and prevention as well as for managing diagnosed conditions. COVID-19 accelerated this trend, which is enabled through our smartphones, broadband connections, sensors and the IoT of medical and healthy things, and interoperability increasingly made real through APIs and the Matter standard (tagline: “the Foundation for Connected Things”) which is getting lots of attention at #CES2023. These Connected Things Matter for our health. Increasingly, people as health consumers — paying more out of pocket for health care and demanding immediate, closer-to or at-home convenience — are adapting to and adopting self-care beyond vitamins, minerals, and supplement consumption. Thanks to Withings and others in evolving DTC lab test ecosystem — such as EverlyWell, the Cologuard test (from Exact Sciences), Let’s Get Checked, WellnessFX, Color Genomics, DirectLabs, and of course, 23andMe and Ancestry et. al. — we can add even more sophisticated and empowering clinical lab capabilities to our HealthQuarters self-care portfolio.

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