Rethinking Health - #1
Learning from COVID, shaping the future of health and healthcare, and convincing the world that health is wealth
Welcome to the inaugural post of Rethinking Health. My name is Ben Williamson and I’m a venture capitalist, recovering corporate attorney, co-founder of a health and fitness facility, an eternal knowledge seeker with a growth mindset, and a connoisseur of all-things health. Rethinking Health is my mission to discuss health, venture capital, innovation, and start-ups within the context of redefining and pursuing preventative population health. If you’re wondering why we’re all here, might I suggest this sorta brief introduction which does a moderate job in articulating why I think I’M writing this post.
Much internet ink has been spilled – and mostly rightfully so – discussing how the world is going to “grow” out of the COVID pandemic. You know, what will the new normal be and stuff? I’ve read pretty intelligent commentary on the future of education, communication, work, travel, entertainment, and the like. But there has sort of been a dearth of good content on the future of HEALTH – which wouldn’t be at all surprising to me if health wasn’t, you know, front-and-center right now. To be clear, this post isn’t even really about COVID. And it isn’t about what I think health WILL look like post-COVID. Instead, it’s really about what I think health OUGHT to look like, many of the essential factors of which have been greatly exacerbated or highlighted by COVID.
Let’s start with a “State of the Union” of health pre-COVID, shall we?[1] (Spoiler: it ain’t good.)
Conservative estimates suggest Westernized countries could be crippled by the costs of “managing” metabolic driven disease. Chronic disease will generate $47 trillion in healthcare costs globally by 2030 if the epidemic (chronic disease, not COVID) is unchecked. That’s more than the annual GDP of the six largest economies in the world;
Chronic disease affects one out of two Americans and causes seven of 10 deaths in the United States;
50 million Americans (approximately one in six) have an autoimmune disease (more than cancer and heart disease combined);
One in 45 children now has autism spectrum disorder, up from just one in 500 in 1999. More children will be diagnosed with autism this year than with AIDS, diabetes, and cancer combined;
Alzheimer’s is now the sixth leading cause of death in the United States; the number of deaths has increased by 89 percent since 2000. Alzheimer’s kills more people than prostate and breast cancer combined;
The rate of type 2 diabetes in children and teens is increasing by almost 5 percent a year;
100 million Americans—nearly one in three—have either pre-diabetes or diabetes. The estimated cost of diagnosed diabetes in the US alone was $327 billion in 2017[2]—that’s up 26% from 2012;
The United States spends $3.2 trillion a year on healthcare. That’s the equivalent of 18 percent of our gross domestic product, or roughly $10,000 for every man, woman, and child in America.
The TL:DR here is we’re spending trillions in this country on healthcare (a number which is growing so rapidly it’s going to cripple our country if left untouched) and all that money is not only NOT reversing chronic/metabolic disease, but it’s not even adequately managing it (lotta negatives in that sentence, sorry). One could argue (not me, because I’m a political atheist according to my wife) that every political candidate/pundit/person-who-yells-in-all-caps-on-social-media pontificating about who is going to pay for health care is arguing a point that is wholly irrelevant and premature. First, we must figure out how to focus on preventative population health, thereby beginning to reverse the above health trends and thus driving costs down (WAY DOWN). Now, let’s discuss a few things it seems that the gen-pop is appreciating during this pandemic that could really serve as a silver lining, if we decide to actually learn from them.
Prioritizing Health
In a miraculous turn of events, most people are trying to prioritize their health right now. Everyone can visualize the person who was wholly unhealthy pre-COVID but has spent the last eight weeks locked in their apartment in an attempt to “flatten the curve”. It’s hard to argue that is not a pretty drastic change to their health priorities, though we’ll find out simply quarantining isn’t enough to be healthy (remember, sitting on the couch all day is the new smoking). From a psychological/biological perspective, it makes sense why people have made drastic changes, though. People are understanding what those who have (or have family with) chronic disease already know – basic health is really a precious thing that you don’t fully appreciate until someone threatens to take it away. It has transitioned from an afterthought to a survival mechanism now for most people. You know, it’s the “if my doctor doesn’t tell me I’m unhealthy, then it’s easier to just not think about it” laissez faire approach that plagues this country. The punchline here is that I hope some people are now realizing that they shouldn’t take their health for granted and it would make sense to assign some more value to it going forward. TBD here.
Aside from the renewed appreciation for health, there is also significant evidence that suggests that being healthy really affects COVID outcomes (duh?). In other words, people with pre-existing conditions (such as asthma, high blood pressure, obesity, autoimmune disease, diabetes, Alzheimer’s, heart disease – virtually all of which are lifestyle and diet related) are more vulnerable to becoming severely ill with the virus.[3] In fact, some research suggests that relatively young people (i.e. 50 years old) who have a preexisting condition are more likely to be hospitalized for COVID than a healthy 70 year old.[4] Other things that may be less obvious to the general population include Vitamin D deficiencies being a huge risk for the virus, which is a pretty big issue considering 70% of the US is vitamin D insufficient and 30% is deficient[5]. Quarantining inside 24/7 and not getting any sun certainly isn’t helping here. To make matters worse, COVID realities (and the response to the virus) have exacerbated many of these health problems – for example, there have been increases in mental health issues, relationship issues, lack of spending time outside, increases in stress and worry, lack of sleep, and increased consumption of unhealthy/convenient foods, all of which leave us even more vulnerable to viruses and other health issues. And even though I concede many have “prioritized health”, just staying quarantined does little to increase our resilience to the virus so that we suffer less and recover faster. Especially as this country re-opens, and many suggest most young people will ultimately get infected at some point. Our imperative during this time, then, is to make sure we do the opposite of what most people are used to doing: eat healthy whole/real foods, workout or just MOVE multiple times every day, prioritize sleep, foster deeper and happier relationships, spend time with your community (even virtually), practice mindfulness and meditation, get outside in the sun, and for god sakes go play (do fun shit).
Sickcare
Since quarantining to flatten the curve is based on not overwhelming the health system, let’s take a look that, shall we? Our health system is built to diagnose, treat, and manage acute disease. In other words, it’s a purely responsive system. That’s great if most people are healthy and there is little acute disease – costs stay down and health workers are only used when needed. Turns out, this system is very bad when (1) most people are unhealthy; OR (2) there is a global pandemic. It’s very very bad if we have both. For those paying attention (see above bullet points), you know that we’ve nailed both of these. We’re rewarded with hyperinflation of healthcare costs, untenable strain on the healthcare workers (who are amazing by the way) and infrastructure, and some people not getting the care they need (either for “normal” acute disease or for COVID-related illness). Imagine the utopian world where our health system is built around merely ensuring people are healthy and preventing disease. There may be more ongoing costs (i.e. my appointment with my functional practitioner may last 30 minutes, rather than 7 minutes, or I may have someone help me optimize my diet and sleep on an ongoing basis), but the aggregate costs are reduced drastically. Turns out, treating acute disease, prescribing lots of pharmaceuticals, and insuring a largely unhealthy population (Google “pooled risk health insurance”) is unbelievably expensive.
The Need for a Resilient and Sustainable Decentralized Food System
It’s no secret that this pandemic has exposed many of the systemic flaws in our “old” society, like healthcare. But one of the largest exposures and issues that has arisen is the realization that our industrialized food system is incredibly fragile. Even though [producers] (ranchers) knew this before the pandemic laid bare the instability of the industrialized food supply chain, many are just now realizing that the chain isn’t working. But before addressing the brittle industrialized food system, let’s look at what exposed it. It’s simple really: meat packing plants quickly became the fastest growing hot spots for COVID outbreaks. From Grand Island, Nebraska to Sioux Falls, South Dakota and many other Midwestern cities, the infection spread through these massive plants. “Worker safety is an issue in meatpacking plants under normal circumstances. But the proximity in which workers stand to one another while on the line—sometimes shoulder to shoulder, as little as six inches apart—makes social distancing all but impossible during this crisis.”[6] To make matters worse, between the broken national food supply chain and the socioeconomic and racial inequality present in these predominantly blue collar towns, most of these plants couldn’t or didn’t close. (To be clear, an entire post could be written on the gross negligence and mismanagement that occurred in many of these cities, states, and especially within management of these companies.) But let’s focus on the broader issue of why the supply chain is so broken? Four companies control processing of over 80% of the country’s beef, and four control about two-thirds of the country’s pork. Even though only 23 meatpacking plants out of the almost 1,000 in this country closed (some of which have reopened), the nation is experiencing meat shortages and will continue to do so.
The solution is simple, though it won’t be easy. We need to institute a resilient and sustainable decentralized food system – one where food can be processed and connected to the local economies in which it was raised. One potential solution is the PRIME ACT, which would repeal the ban on sale of meat processed by custom slaughterhouses that meet state regulations and basic federal requirements. This would result in drastically increased DTC (direct-to-consumer) sales of meat, which is how many people (especially younger generations) prefer to shop today. A system like this would resemble the one this country had decades ago and would be vastly better for consumers and local producers alike and would help drive local business and the economies of these states in the middle of the country. Call your representatives if you’re so inclined – I did.
In case that’s not enough, a decentralized and local food system would encourage (and allow) producers to adopt a sustainable and regenerative agriculture model, which would help improve our health, soil, and the environment. It’s largely irrefutable that industrial monocrop/monoculture farming (the agricultural practice of growing a single crop year after year on the same land, which notoriously utilizes a plethora of chemicals, fertilizers, fuels, and pesticides) and CAFOs-(Confined/Consolidated Animal Feeding Operations) are worse for our health, the soil, and the environment (and animals). But in an attempt to avoid some confrontation, let’s merely look at why Regenerative agriculture is good for all of those things.
1. Regenerative agriculture focuses on grass-fed pasture-raised animals. There is decent support for the fact that grass-fed animals are indeed healthier for humans than factory-raised feed-based commercial meat (i.e. CLA profiles, superior fatty acid profile, no antibiotics or growth hormones, etc.). To be fair, as Robb Wolf has pointed out, there is lots of nuance here and some questions as to how much healthier it really is.
2. According to this paper, from the March/April 2016 issue of the Journal of Soil and Water Conservation, most agricultural soils have lost 30% – 70% of their soil organic carbon (SOC), which has led to a decrease in food production in some areas.[7] Some decently credible sources have predicted some places in the country only have 60 harvests left, because the soil quality has been eroded so drastically. Regenerative land management practices (which include pasture-raised animals) have been shown to successfully sequester more carbon in the soil than pasture-raised animals emit in their lifetimes.[8] This is a HUGE potential tool to help reverse climate change. (See how Will Harris of White Oak pastures also applies this practices to the solar power industry.) And didn’t you hear? Turns out cow farts aren’t the issue with carbon emissions in the first place[9].
Suffice it to say that in the last ten years we have seen a seismic shift in many legacy industries thanks to unbundling (like TV, news, print, music, etc.) driven by technology. Maybe our food system ought to be next on the list to be decentralized, unbundled and disrupted.
So, What’s Next?
You might ask yourself how anything in this article applies to technology, innovation, and startups, which might be a valid question. I believe there ought to be a shift in the way we think about health, which will pave the way for an abundance of new innovation in the space. For example, I’ve had conversations with the founder of an AgTech robotics company in Nebraska about the potential of mobile/automated meat processing facilities that could go to local ranches and keep food processing local –- it would also be more sustainable, environmentally friendly, humane, safe, etc. Additionally, if we learn that we have to prioritize health all the time, not just when we’re sick, the preventative health industry will explode with opportunity. To be clear, and contrary to what many believe, health doesn't stop with the conventional definition of "absence of injury, sickness, and disease". Comprehensively, health includes those things. But complete and optimal human well-being is also comprised of: what and how we eat, our body's movement and fitness, our sleep and recovery, our relationships and community, and our mentality and mindfulness. But regardless of how you define it, health and healthcare are broken across the globe. In the current paradigm, we have (relatively) very few healthy people in the world and our healthcare system really is a sickcare system built to serve sick people, not help people pursue health. As a class, we are afflicted with largely preventable chronic disease and metabolic illness such as obesity, diabetes, neurodegenerative disease, heart disease, autoimmune disease and stroke. Chronic disease is sabotaging our health, destroying our quality of life, shortening our lifespan, bankrupting our governments, and threatening the health of future generations.
The good news? Humans have the intelligence, innovation, imagination, and grit to change this. I’m excited for the new innovations and companies solving these critical health problems and rebuilding the system. These are the companies who seek to prevent and reverse chronic disease (instead of just managing it), invent advanced lab and bio-metric testing, advance genetics and cell therapy, accelerate impactful personalized health, nutrition and fitness, re-imagine childhood health and school food, progress large scale regenerative agriculture including soil regeneration, create next generation sustainable agriculture and local food production, and rebuild the healthcare system. Remember: health is wealth.
People to check out if you’re interested in these topics:
Preventative/Lifestyle Health Generally:
People Leading the way for Sustainable Decentralized Food System:
Diana Rodgers – Also, preorder the Sacred Cow book
Other Cool People:
Ryan Holiday talking about applying Stoicism to the COVID era.
[1] SOURCE: Chris Kresser (and a little Robb Wolf) citing: National Center for Chronic Disease Prevention and Health Promotion. 2016; U.S. Department of Health and Human Services 2015, 295; Johns Hopkins University Partnership for Solutions 2000. A new report from the Centers for Disease Control; American Autoimmune-Related Diseases Association.
[2] American Diabetes Association data.
[3] https://digestivehealthinstitute.org/2020/04/10/how-to-reduce-risk-from-covid-19/; https://www.worldometers.info/coronavirus/; https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/get-your-household-ready-for-COVID-19.html; https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_;
[4] Chris Kresser podcast with Tom Bilyeu (Impact Theory).
[5] Rhonda Patrick, PhD on Joe Rogan podcast.
[6] https://thecounter.org/trump-tyson-foods-meat-plants-defense-production-act-covid-19/.
[7] https://sustainabledish.com/meat-is-magnificent/.
[8] https://blog.whiteoakpastures.com/blog/6-reasons-to-eat-grassfed-beef-pasture-raised-poultry-2020.
[9] More here too: https://www.resilience.org/stories/2020-05-07/false-solutions-to-climate-change-agriculture/.
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