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Aging, Prevention and Vaccines

Welcome to what I expect will be a fulfilling conversation about health and wellness. I would like to begin our conversation by telling you a bit about myself, and about why I view your health and your community’s health as an asset that we must all value and protect.

My life is certainly very full and fulfilling. I’ve practiced and taught emergency medicine for more than three decades, and had the privilege to work alongside many of today’s medical leaders and innovators. I’ve had the opportunity to participate in global humanitarian efforts, including the disaster response following the 2010 earthquake in Haiti. With the support of incredible mentors and colleagues, I’ve worked hard to establish the specialty of wilderness medicine, which increasingly sets the standards for practicing medicine under austere circumstances. Stanford University and the Redlich family generously allow me to continue my life’s work, which is increasingly focused on clinical care, research and education that will improve the public’s health.

As I survey the various opportunities to engage in public health service, I believe it is essential to choose initiatives that will allow the biggest bang for the buck. In other words, I wanted to make discoveries and support programs that will have maximal impact in improving health for large numbers of individuals, including populations.

In a country where we spend more on healthcare than any other nation in the world, our metrics put us somewhere between 25th and 40th worldwide in terms of life expectancy, vaccinations, maternal-child mortality, and other global health rankings. From a United States perspective, we need to step back and ask, “Where are we missing the boat? What could we be doing better?” If we don’t shirk from the uncomfortable truth, part of the answer is that many children and adults don’t complete their recommended immunization series. As we know from life in general, the basics are where we must begin. Vaccination against communicable infectious diseases is the foundation upon which must be built any sensible program of public health.

When I was a young child, every parent worried about their son or daughter getting polio. We don’t worry about that any more because of vaccines. When I was a medical student, the risk loomed large of healthcare workers contracting hepatitis. We worry about that much less now because of vaccines. When I responded to the earthquake in Haiti, I witnessed firsthand the ravages of tetanus in many poor victims who had never been vaccinated. When I close my eyes, I still picture them suffering and it haunts me.  In a global era when people move freely across geopolitical borders, vaccination has never been more important – both here in the United States and in every country around the globe.

As Director of Special Projects in the Division of Emergency Medicine at Stanford, I’m always looking for opportunities to contribute to better health outcomes. My goal is to help as many people as possible begin on a path to optimal health and wellness through illness and injury prevention strategies based on a true assessment of their situation, risks, behaviors, capabilities and resources. Having to seek care in the emergency department because one has become ill and injured is a necessity for which we must always be prepared, but when the visit can be avoided because something sensible was done, like vaccination or wearing a seatbelt, everyone wins. 

Our responsibilities extend beyond our neighborhoods.  The medical profession has a strong social responsibility to “give back” to underserved communities and help eliminate health disparities. Everyone is entitled to the opportunity to enjoy and healthy physical and emotional existence, and to the extent possible, should benefit equally from the ministrations of medical science.

We all walk different paths, but in many ways we are alike. We all suffer from a certain lack of understanding about fundamental health care issues, including vaccinations. When I entered medical school, I was informed “Today you are starting behind, and you will spend the rest of your life trying to catch up.” Imagine how if this is true for doctors, what it is like for patients, who have to process an unprecedented amount of new, and often conflicting, information in order to navigate the healthcare system. What do a pregnant teenager, a military recruit, a college-educated search professional, and a demented octogenarian who must take fifteen daily medications all have in common? None of them truly understand information and instructions about vaccinations, medications, diet, physical activity, and other health-related information.  These vulnerabilities could cost them their health and even their lives. It may not be their fault, but that’s the way it is.

Health literacy, which is the ability to locate, understand, evaluate, communicate, and use health information to make informed health decisions, is one of the keys to a healthy life. Low health literacy is an equal-opportunity health threat, affecting rich and poor, young and old, and people of all racial and ethnic backgrounds.

When one considers vaccination, it is easy to appreciate the importance of health literacy. For example, there is a great deal of misinformation on the Internet about vaccines. That situation leads many people to be confused about whether to have vaccinations themselves and whether or not to have their children vaccinated. Health care providers have an obligation to keep the record straight on vaccinations and other important public health topics. That begins with their having a good understanding of the facts and issues.

Being current with vaccinations is important, because it helps protect our personal health and avoid the risk of infecting others. There are a number of diseases that a simple vaccination can help to prevent. The list includes influenza, tetanus, diphtheria, chickenpox, whooping cough, hepatitis, shingles, and many others.

I use the opportunities I have as a physician, professor, author, adviser, educator, and public figure in the health community to do as much as I can to support Americans’ health literacy about the leading-edge science, including disease prevention through vaccination. As I grow older, I appreciate that while it may take a greater effort and more focus to learn with the same pace and intensity as I did in my youth, It is not only possible, it is essential. Just like a muscle, the brain must be “exercised” to maintain its capacity. While others keep your mind stimulated with fiction, art and music, I will do it with facts and the challenge for you to learn and maintain your rational decision-making ability.

My colleagues in the neurosciences look at brain fitness to see what we can effectively apply to older adults. When I went to medical school, we were taught that when a person reaches his or her sixth or seventh decade, they can’t really learn anything new and may soon be put out to pasture. We know now that not only can an elder person learn, but they can grow their knowledge and abilities well into their 90s and beyond. There’s no need to slow down because someone says you’re supposed to. Put all that great experience and wisdom to good use.

Speaking personally, I intend to remain fit into my 60s and beyond. I’m a father, I have a lot of responsibilities, and I take them seriously. I work out every day for about an hour and keep myself in shape. I do a lot of cross training, because I’ve found that if I do the same routine two days in a row that makes it more difficult. I don’t run that much anymore because my knees can’t take it, so I’ve learned to adapt to an exercise bike and the lap pool. The only exception is when I’m in the wilderness, but when that’s the case the odds are that I’m exercising more than an hour a day anyway.  

Another good health habit is that I’ve always stayed away from tobacco products. Like most kids of my age, I was surrounded by smokers. At that time, smoking was considered cool, and the epitome of being an American. The truth is far from that perception. The landmark 1986 report from the 13th Surgeon General of the United States, Dr. C. Everett Koop, was the first to conclude that secondhand smoke causes disease. As the 17th Surgeon General of the United States, Dr. Richard Carmona, said in 2006 when he issued the Surgeon General’s Report on the health effects of secondhand smoke, “The debate is over. The science is clear. Secondhand smoke is not a mere annoyance but a serious health hazard.”

Although many states and hundreds of cities have passed smoke-free laws, millions of Americans continue to be exposed to secondhand smoke. More than 200,000 Americans die from tobacco-induced illnesses every year. Nearly 50,000 of those who die from tobacco-induced illnesses are non-smokers.

Non-smokers exposed to secondhand smoke at home, school, or work increase their risk of heart disease and cancer by up to 30 percent. Even brief exposure to smoke damages cells, starting a process that can lead to cancer, and increases the risk of blood clots, which can cause heart attacks and strokes.

I’m also increasingly careful about what I eat. My lipid profile is dominated by genetics that require me to be on medications. I’m learning to manage my sweet tooth by using the all-natural sugar substitute Susta. I stay within 5 pounds of my target weight.  I eat less beef and way more vegetables and fruit. Chicken and seafood have moved up my dietary food chain. Better late than never, I’ve discovered whole grains, nuts, and fruits, and the concept of portion control. Peanut butter and ice cream have transformed into almonds and fruit cobbler. My typical breakfast is oatmeal, yogurt, fruit, and a glass of orange juice. Lunch is a Clif Bar, and then I have a full, but portion-controlled dinner. If I’ve been good during the day, ice cream re-enters the picture.  Dark chocolate is my culinary vice. Remember, when you exercise, your body acclimatizes to burn calories, and you can have more fun on the intake.

Wellness is multi-factorial. If you don’t leave it all to luck, then you will eat right, sleep right, get plenty of exercise and stay in shape, never use tobacco products, drink alcohol only in moderation, wear your seatbelt, obey traffic safety laws, wear a helmet, use sunscreen, and be sure to obtain all of the recommended vaccinations. 

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