Jane Sarasohn

“The future of love is bound to the institutions that have historically shaped and defined it,” Ipsos’s What the Future: Love report begins. Consider: religion, government, financial institutions….and the health care ecosystem, as well. On this Valentine’s Day 14th February 2023, it is a good time to consider this convergence as health politics, financial well-being, and emerging technologies will be re-shaping institutions and consumers in the coming months and near-term.           The Ipsos researchers have been assessing the future of many aspects of our lives over the past couple of years, such as the future of wellness, aging and health along with the future of work and play, spending and wealth, eating and beauty, among other facets of human life. Ipsos’s territory diagram arrays the driving forces influencing the future of love — with health across many dimensions influencing our love-futures. Technology, in particular, will be playing a growing role in helping us find love, nurture love, and give love back to our community (looking well beyond Tinder toward the role of AI and other emerging tech’s). Beyond some obvious things, in looking at love, Ipsos makes the connections between the emotion and its impacts on finances, housing, shopping/retail, and of course health and well-being.           While the Ipsos report features mostly U.S. consumer data, the company’s Global Advisor survey conducted between December 2022 and January 2023 illustrates how people across the world are looking at love and romance. Overall, 22% of people globally said finding love will get easier, 35% thought finding love would stay the same, and 43% around the world thought finding a romantic match will be more difficult. For those in the U.S., the same percentage of folks — 43% — believe finding love will get tougher or stay the same. Only 13% of U.S. consumers think finding a romantic match will get easier. “For romantics around the world,” Ipsos concludes, “things are looking more hopeless than hopeful.” Consider declining trust in institutions, which I’ve gone on about more than you might have wanted to hear in this Health Populi blog. Notably, the Edelman Trust Barometer has been tracking trust-erosion among the world’s citizens for the past several years, most recently here in the 2023  study. But trust is a precursor requirement to health engagement and engaging in the civic commons. And Ipsos’s Future of Love research also calls out the two institutions that have defined relationships — religions and governments — and peoples’ eroding faith in both. At the same time, global citizens are tending to lean into greater flexibility in relationships across different dimensions.         Take “Financial institutions [who] are forced to adapt,” the Ipsos futures team asserts in their analysis of the driving forces vis-à-vis consumer preferences. Relationships are shifting, but institutions have been slow to adapt — yes, financial organizations, and yes, health care institutions, as well.                     Health Populi’s Hot Points:  Ipsos looked at what factors are splitting couples up, and why people are staying together. It’s Valentine’s Day and I’m one of those romantics Ipsos talks about….so let’s check into “why we stay” with our half-full drinking glasses. It’s love and belief in our mates along with staying together for the benefit of our kids for over one-half of those likely to stay in their relationships. The second major factor is financial stability, for one-in-two people wishing to stay in their relationship. Then come legal and financial issues that make it tough to break up as well as the fear of being alone. And 30% stay for the health insurance. The Ipsos study raises that “Philosopher of Love, Huey Lewis’s” refrain that the power of love is, indeed, a curious thing. The power of love in its best expression and incarnation is among the most powerful drivers of health and well-being. To bolster health citizens’ ability to flourish and be well, our institutions must develop policies and procedures that support people to be their best loving selves if we are to address the Deaths of Despair, growing social distancing, and increasing threats to our social fabric and communities. It’s the right time to bake love and generosity of spirit into health insurance plans, health care delivery settings, clinical trials protocols, data hygiene and security, and advertising and branding across the health/care ecosystem. As the lyrics of “The Power of Love” attest, You don’t need money, don’t take fameDon’t need no credit card to ride this trainIt’s strong and it’s sudden and it’s cruel sometimesBut it might just save your lifeThat’s the power of love. And as my Valentine’s Day gift to you, straight from The Huey Lewis Official Page, here is the complete “The Power of Love” video with Back to the Future goodness…

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Joke if you must about Big Game cuisine being typically packed with calories and fat and carbs….and as such, not-so-great for health. For me, the ads are the attraction during The Big Game (along with the Philadelphia Eagles). In this year’s ad line-up, health will be featured in high-priced spots as it has for the past few years. Last year, I was intrigued by a female-focused 30-second spot from Hologic, educating viewers on cervical cancer, discussed here in Health Populi.         This year, my eyes are on Bayer Aspirin’s campaign “encouraging sports fans to keep their heart in the game” as the “Official Sponsor of Fans’ Hearts.” This campaign is incredibly well-timed given that the rate of heart disease in the US has been increasing in the past few years after improving for decades. Heart disease remains the leading cause of death in America, accounting for one in every five deaths.                 Bayer offers four recommendations for heart health self-care: Eat Right, packing a daily diet with fiber and low in saturated and trans fats. Stay Active, with the goal of getting at least 30 minutes of physical activity a few days a week – especially doing things you like to bolster fun and engagement (my go-to source on this is University of Michigan’s expert Michelle Segar of Don’t Sweat and The Joy Choice fame) Don’t Smoke – because smoking is a major risk factor for ill health for the heart and beyond; and, Reduce stress, because it damages linings of blood vessels and can lead to inflammation that is a risk for fat and cholesterol building up in your arteries. So why a cardiac health education campaign during the Big Game LVII? Last year, the Big Game had over 208 million viewers watching Game #LVI. according to Nielsen’s estimate including home viewers along with folks watching in bars and restaurants. That’s a lot of eyeballs and pairs of ears to watch and learn about heart health. Bayer’s press release said that focusing on digital live sports, “capitalizes on the community of sports to empower fans with the accessible tools they need to keep their hearts in the game.” Check out the Bayer Aspirin video here that you’ll see sometime during Super Bowl LVII (oh, and GO EAGLES!).                         Health Populi’s Hot Points:   Self-care isn’t selfish, the American Heart Association reminds us. There are many things we can do to lessen stress and take care of our hearts, some shown in the infographic from AHA. These are evidence-based tactics that are free or inexpensive. While caring for pets isn’t cheap or free, our fur family (and other non-furry animal friends) can generate mental and physical health benefits. Caaring for pets — like walking your dog, which has lots of proof-points for healthy aging, for example — is a wonderfully engaging health-promoting activity, for mind, body, and spirit. To further empower us on caring for our hearts, just-in-time on Valentine’s Day next week, a new book from Dr. John Whyte will be available titled Take Control of Your Heart Disease Risk.  Dr. Whyte is Chief Medical Officer at WebMD and a passionate advocate of self-care based on evidence-based approaches. His book is based on the fact that most heart disease is rooted in peoples’ lifestyle choices, so people have the power to shape their heart-health futures. In terms of the consumer-facing heart-health ecosystem, in addition to Bayer’s 4 to-do’s listed above, there’s another DIY aspect to health care in our DIY ecosystem: monitoring blood pressure. Knowing one’s numbers can be a powerful, empowering thing. And today’s consumer-facing blood pressure monitors aren’t your grandfather’s. They are increasingly digital and app-ified, helping you keep track without remembering in your head or meaning to write your readings down (but forgetting to). I’ve been tracking the evolution of this digital health technology for over a decade: a good example of that trajectory of digital heart tech for consumers comes from OMRON whose Connect app (which syncs with every one of the company’s connected BP monitors) recently garnered a TWICE Picks Award for best digital health service at CES 2023. I’m especially keen to see how the app’s “Community Features” will roll out later in 2023 which will allow OMRON Connect app users to join up, share experiences, and support each other. (Remember: health is social, and we can go farther, together). Having had a father who managed heart health risks his whole life until he succumbed to heart failure at 86 years of age, I personally witnessed how those lifestyle decisions shaped his longevity and well-being. He was that role model for me, and so in the past several years, I’ve been monitoring my blood pressure pretty religiously. Doing so is a daily reminder for self-care and as AHA reminds us, not selfish at all. You do it as much for the people you love as for yourself. Happy Big Game. Happy Valentine’s Day. Happy, Healthy You. (Oh, and did I say, “Go Eagles?!!”).

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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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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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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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The U.S. is an outlier in the world for high health care spending, as well as in low achievement for life expectancy at birth — 3 years less than that in peer OECD countries — discussed in U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes, the latest look into American health system performance in a global context from The Commonwealth Fund. Another study published in JAMA this week talks about the Organization and Performance of US Health Systems, calling out the fact that, “Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.” Together, these two reports kick of 2023 with the data-based picture that America continues to spend more than other nations and their healthcare systems, and get a much lower return on that investment.             While the United States spends more on health care than any other high-income country, the nation often performs worse on measures of health and health care. For the U.S., a first step to improvement is ensuring that everyone has access to affordable care. Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services. Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.             The second chart shows the sad declining line of three years lower life expectancy in the U.S., despite the much-higher spend on health care in America depicted in the first graph. Note the hockey-stick line down and to the right for the U.S. here, demonstrating the sharp fall in life-years expected at birth in the U.S. falling since 2019 – a relative high mark just pre-pandemic. The OECD life-span average at birth was 80.4 years in 2021; in the U.S., it was 77 years.           A key differentiator between U.S. health care and other high-income countries is that America is the only one of its nation peers that does not guarantee health coverage for all. This factor is something that most U.S. residents value, including majorities of Democrats and Independents (and just over 1 in 4 Republicans), a Gallup poll conducted in January 2023 found.           Beyond the lack of universal health care assurance, several other differentiating driving forces erode Americans’ life-spans and quality of life-years: the include, The highest level of obesity among the richest OECD countries, nearly double the OECD average at 42.8% of the nation’s population compared with 25.0% on average The greatest likelihood of adults facing multiple chronic conditions (such as diabetes and other issues for which obesity is a risk) The highest level of deaths due to COVID-19 equal to 3,253.4 per million U.S. residents, compared with, say, 2,413/mm in France and 1,301 in Canada. among others — and most starkly and particularly, gun violence.           On this day marking the memorial service to celebrate the life of Tyre Nichols in Memphis, this chart should give every person in the U.S. pause to, First, pray or be silent for a moment of grace; and second, To ask what we can do to turn this desperately tragic determinant of health around. A sad statistical artifact of this last major difference in U.S. public and individual health is the level of deaths that could be avoidable — quantified in the Commonwealth Fund report. The level of avoidable deaths per 100,000 people in the U.S. was the highest (meaning the worst outcome) in the U.S. compared with other OECD countries: that was 336 in the U.S. versus the OECD average of 225.             Health Populi’s Hot Points:  The level of national health spending in the U.S., and lower ROI in terms of health outcomes, provides important context for American families and their households economics. The chart here illustrates that as of December 2022, most adults in the U.S. were living paycheck-to-paycheck — including those earning over $100,000 a year. This proportion of household financial stress among high-income consumers in the U.S. sharply rose since May last year, the graph shows, when that percent was 1 in 3 instead of 1 in 2.                 Affordability being top-of-mind for patients-as-payers, this last chart illustrates what U.S. households were facing in December 2022 for price changes impacting consumer spending. These stats are from the Bureau of Labor Statistics’ latest report on consumer price inflation published January 12, 2023.  Note that hospital services top the list of fastest-inflating consumer goods prices rising between January 2000 and December 2022. Hospital services exceeded 227% increases, and medical care services 132%. In between that healthcare services price inflation “sandwich” were college tuition and textbooks, followed by childcare and nursery school. The Commonwealth Fund report reminds us that U.S. patients — now health consumers and medical bill payers with deductibles — bear greater shares of out-of-pocket health care spending, too, compared with health citizens in other nations. While the specter of COVID-19 was been replaced by consumers’ financial pressures, supporting patients-as-payers to take control of their health and finances will be key for all businesses to strategically embrace in 2023, Ipsos’s latest work on the ever-adapting consumer informed me this week. The convergence and blur of health/care, financial health, and retail has never been clearer.

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While the same proportion of Black and White patients say they are looking for a doctor with empathy and compassion, there are relatively large differences between patients based on their race, found in the Everyday Health-Castle Connolly Physician-Consumer study.             The survey was conducted in December 2022 among a group of 1,001 U.S. consumers and 277 Castle Connolly health care professionals. As the first bar chart illustrates “where patients differ, “Black people were nearly twice as likely as white people (41 percent versus 22 percent) to completely agree that they would be more comfortable and more likely to listen to advice from physicians who shared their race or ethnicity or sexual orientation. Black people were also more than twice as likely as white people (41 percent to 17 percent) to completely agree that they would have better health outcomes with a doctor of the same race, ethnicity, or sexual orientation,” the study’s website explained.             When asked to rank what characteristics patients want in their physicians, more Black patients identified the doctor’s respect for an sensitivity toward my gender, race, ethnicity, and socioeconomic status along with providing easy access to technologies such as online scheduling and telemedicine. More white patients prioritized the doctor’s ability to listen to my questions and thoughts and clinical experience. The bottom-line learning was well-articulated by Dr. Patrice Harris, a psychiatrist based in Atlanta, Everyday Health’s Chief Health and Medical Officer, as well as past president of the AMA: “Based on history and prior experiences with the overall health ecosystem, many African Americans prefer a physician that can understand their lived experience, and who can understand issues around discrimination and prejudice and racism,” Harris noted.                 Health Populi’s Hot Points:  Emotional support is just as important as medical support, Accenture observed in the Health and Life Science Experiences study conducted in 2021. Here is a snippet of how I explained the Accenture research here in Health Populi when it was published: “Making healthcare more human begins with a step in the patient’s shoes,” Rich Birhanzel wrote in Accenture’s Humanizing Healthcare blog in July 2021. Some work-flows that health care stakeholders can take on to walk in those consumers’ shoes could include: Giving people access to all of their health data and tools to understand it Address health disparities at the root of the problem to help make health and wellbeing equitable Use technology creatively to de-fragment disjointed health experiences, and do so in personal and convenient ways Partner inside and outside of the legacy healthcare system to re-imagine health care through the standards of the best retail and consumer services Finally, blend digital, virtual, and face-to-face care to, in Accenture’s words, “provide effective, trusted and reliable services.” As the French phrase goes, “plus ça change, plus c’est la même chose.” The more things change, the more they stay the same. My recommendations hold true in 2023, and especially tied to the Everyday Health-Castle Connolly study on what patients want in doctors. Empathy and emotional support is also what patients want from the health system, writ large.

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Our grocery stores were essential touchpoints for us during the COVID-19 lockdown era and thereafter, addressing our basic needs for food and medicines and even social health from early 2020 and since.             Grocery stores have been morphing into health/care destinations for the past decade, in the best cases bolstering nutrition, supporting medication adherence and patient outcomes, and helping us curate healthy grocery carts with nutritionists as part of the store pharmacy team. Now Kroger continues to expand its health/care footprint and capabilities, becoming a clinical trials channel as announced in its January 24th press release. The focus on the first clinical study will be for microbiome-based biomarkers associated with colorectal cancer to address gut and immune health. The Little Clinic retail health sites operated by Kroger’s affiliate will collaborate with Persephone Biosciences to bolster recruitment in the ARGONAUT clinical study (NCT04638751). Kroger Health’s president Colleen Lindholz explained: “With our team of more than 24,000 healthcare professionals, under the umbrella of America’s grocer, we are positioned at the nexus of food and healthcare, which provides us with the unique opportunity to increase accessibility to clinical trial opportunities. As a trusted community healthcare destination, we envision a future where our work transforms the clinical trial landscape and provides expanded trial access to the people we serve.” Kroger intends to expand this effort to additional locations beyond the initial Toledo, Ohio, market area.             Health Populi’s Hot Points:  How appropriate for Kroger Health to launch its clinical trial program with a study focused on gut microbiome…..with the company’s growing focus on food-as-medicine and population health discussed here in Health Populi. We observed consumers’ growing their self-care muscles and skills from the start of the pandemic, quantified in 2021 by NCSolutions in its study on how people were using consumer packaged goods in the public health crisis. The graphic illustrates some of NCSolutions’ insights: more people amped up their purchases of hygiene and protein. Two in three consumers saw healthcare purchases via CPG products as essential for their home supply’s “Pandemic Pantry.”               Another part of the survey noted that 42% of consumers said that grocery shopping was a way to get out of the house and feel normal — that’s the “social health” aspect that grocery shopping afforded many people. So many consumers took advantage of the store-as-social-opportunity that one point that the H-E-B President Scott McClelland asked shoppers to limit the number of family members accompanying them to the grocery store to enable physical distancing. Social health happens in many forms in local communities. And now, clinical trials “in aisle 9,” as they say, with an on-ramp from Kroger Health in peoples’ hometowns. Kroger joins the clinical trials community on the retail health side of the market with CVS Health and Walgreens. Here is CVS Health’s launch announcement on their clinical trials program, announced May 2021. Here is Walgreens’ press release, from June 2022, explaining that the effort was designed, “to break through barriers to engaging broader and more diverse communities….[coinciding] with recent steps taken by the U.S. Food and Drug Administration to increase racial and ethnic diversity in clinical trials given 20 percent of drugs have a variation in responses across ethnic groups, yet 75 percent of clinical trial participants are white, while only 11 percent are Hispanic and fewer than 10 percent are Black and Asian.” The growing retail health connections to people living their lives at home and in their communities can positively re-shape clinical trials results and truly real-world evidence from Everyday People’s Everyday Lives. Kudos to these organizations working to address the challenge of health equity, health access, and healthier, longer lives for all health citizens.

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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 peak of venture investment for digital health was in 2020 and 2021, precipitously declining later in 2022. And the outlook for 2023 is practical and Show-Me: that is, demonstrate clinical outcomes and return-on-investment before “I” (for investors) can take a leap of faith to spend a dollar, a Yen, a Euro, or British pound on a shiny new-new healthcare thing. If it’s January, then CES and JP Morgan convene their influential annual meetings which feature health technology for globally engaged health industry stakeholders — investors, surely, but also providers, innovators, analysts, and insurers.       In my January 2023 column for Medecision. I weave the pragmatic story together based on datapoints from JP Morgan’s 2023 annual healthcare meeting in San Francisco and CES 2023 held in Las Vegas the previous week. Check out the full plotline here on the Medecision blog portal.

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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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For the third year in a row, citizens in most of the world see business as the most-trusted institution, above government, media, and NGOs, found in the 2023 Edelman Trust Barometer, unveiled this week at the annual World Economic Forum in Davos, Switzerland.                       The Edelman team conducted this 23rd annual study in November 2022 in 28 countries, among over 32,000 people — some 1,150 residents per country polled. (Note that Russia, studied in the surveys between 2007 and 2022, was not included in the 2023 research). The first chart arrays the Top 10 findings of the 2023 Edelman Trust Barometer, with the over-arching theme of Navigating a Polarized World. In 2022, Edelman coined the findings as “The Cycle of Distrust,” in 2021 “Business Most Trusted,” and in 2020, “Trust: Competence and Ethics.” This survey report is the first of several that Edelman will produce in the coming months: it’s a global look at the top-line findings, so I will distill what I can regarding the U.S. insights along with those touching on health. But stay tuned for more granular health insights here in Health Populi. For the 2022 health/care specifics on Trust, I wrote an essay for Edelman on “Trust as a Determinant of the Health Economy” published on Edelman’s site last spring.             With polarization the central theme of this year’s findings, Edelman identified the six nations with most severe polarization felt by people living in each country; these include Argentina, maximally challenged by polarization, and then Colombia, the U.S., South Africa, Spain, and Sweden the five additional “severely polarized” lands. Lease polarized, you might want to know, were India, Malaysia, Singapore, Saudi Arabia, the UAE, China, and Indonesia.           Underpinning our polarization and anxieties are personal and existential fears: on a global level, namely, job loss and inflation on the personal front, and on the societal/existential ledger climate change, nuclear war, food shortages, and energy supplies. Economic optimism is “collapsing” in Edelman’s word, based on responses to the question: :How do you think you and your family will be doing in five years’ time? 24 of the 28 countries’ polled are at an all-time low for this question on being better-off in 5 years. In the U.S. that’s 36% of people who feel optimistic for the 5-year timeframe. Lest you Americans feel totally awful about that finding, note that only 9% of people in Japan, 12% of the French, 15% of Germans, 18% of Italians, 19% of the Dutch, and 23% of Britons feel they will be better off in 5 years.             On the upside for health and trust, the most-trusted institutional leader in this year’s study is scientists, with 76% of global citizens trusting scientists (fairly even with last year with a 1 point uptick in trust). To that point, some good news on the health front, too, when it comes to trust in the World Health Organization, a good proxy for trust in public health and perhaps science-fact. WHO is the most-trusted multinational organization in the world (above the UN and the EU). In the U.S., peoples’ trust in the WHO grew by 8 percentage points for this year’s gauge, the largest percent point increase across the 28 countries studied.             Health Populi’s Hot Points:  Trust, or lack thereof, is a toxic pre-existing condition when it comes to public health. Our positive health behaviors beget a virtuous flywheel of well-being, research has shown. Check out Christakis and Fowler if you don’t believe me, among others who have quantified the statistical viral power of healthy behaviors on our immediate and further-out social networks. Trust is also the precursor for health engagement, Edelman learned back in 2008 when it launched a survey called the Edelman Health Engagement Barometer. I had the great good fortune to work with the team on the study launch and follow-up surveys for several years. We found in the first year of the consumer survey that 3 factors attracted health consumers to engage with organizations for personal health: those factors are, Trust Authenticity, and Satisfaction. Trust in the U.S. among many health citizens is low, and gets in the way of our supporting our own flourishing and that of our fellow Americans. Check out the last chart here, the U.S. Case Study from the 2023 Edelman Trust Barometer which explored partisan differences in America. One in two Republicans said that our differences are “insurmountable.” One in three Democrats said the same. Now, look at the drivers of polarization graphed on the right: over twice as many Democrats trust government, trust media. and believe they will be better off in five years.             A further dive into polarization in the U.S, is illustrated in this last chart from Edelman’s 2023 report, segmenting respondents between higher and lower income strata. You can see on the high income side, 63% of U.S. residents are trusting on the Edelman index; on the lower-income side, see that only 40% of U.S. folks rank low on trust (or higher on distrust in this methodology). Edelman notes that the U.S. is second-highest among six nations with the greatest income-based trust inequality. This trust polarity bodes ill for public health and trust in re-building the drivers of health for a flourishing society. I look forward to seeing future data releases from Edelman this year that focus on health and health care stakeholders and segments of the industry — hospitals, pharma, consumer health, and clinicians. The more we can learn about trust and health, the more we can inform our plans and strategies to help build a more resilient, person-centered, equitable health system for all. As always, thanks to Edelman for mounting this important research every year at this time. While the past few years’ releases have been very sobering, we can’t look away from the reality that people are in pain, polarized, and primed for another year of anxiety and stress.

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