Who you are and where you live shouldn’t determine your ability to survive cancer
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In Canada, nearly everyone has a cancer story to share. It affects one in every two people, and despite improvements in cancer survivorship, one out of every four people affected by cancer still will die from it.
As a scientist dedicated to cancer care, I work directly with patients to reimagine a system that was never designed for them in the first place – a system in which your quality of care depends on social drivers like your appearance, your bank statements and your postal code.
We know that poverty, poor nutrition, housing instability and limited access to education and employment can contribute to both the development and progression of cancer. Quality nutrition and regular exercise reduce cancer risk but are contingent on affordable food options and the ability to stay active in safe, walkable neighbourhoods. Environmental hazards like air pollution and toxic waste elevate the risk of specific cancers, but are contingent on the built environment, laws safeguarding workers and the availability of affordable housing.
On a health-system level, we face implicit biases among care providers, a lack of health workforce competence in addressing the social determinants of health, and services that do not cater to the needs of marginalized individuals.
Indigenous peoples, racialized communities, those with low income and gender diverse individuals face the most discrimination in health care, resulting in inadequate experiences, missed diagnosis and avoidance of care. One patient living in subsidized housing told me, “You get treated like a piece of garbage – you come out and feel twice as bad.”
As Canadians, we benefit from a taxpayer funded health-care system that encompasses cancer care services. The average Canadian enjoys a life expectancy of more than 80 years and Canada boasts high cancer survival rates. While we have made incredible strides in cancer care, we must work together to ensure these benefits are equally shared amongst all people in Canada. We need to redesign systems of care so that they are:
- Anti-oppressive. We must begin by understanding and responding to historical and systemic racism that shapes cancer risk, access to care and quality of life for individuals facing marginalizing conditions. Without tackling the root causes, we will never be able to fully close the cancer care gap. This commitment involves undoing intergenerational trauma and harm through public policies that elevate the living and working conditions of all people.
- Patient-centric. We need to prioritize patient needs, preferences and values in all aspects of their health-care experience. This means tailoring treatments and services to individual patient needs. In policymaking, it involves creating policies that are informed by and responsive to the real-life experiences of patients. In research, it involves engaging patients in the research process and ensuring studies are relevant to and respectful of their unique perspectives and needs. This holistic approach ensures that patients’ perspectives are central to all aspects of health care.
- Socially just. We must strive for a society in which everyone has equal access to resources, opportunities and rights, and systemic inequalities and injustices are actively challenged and addressed. When redesigning the cancer care system, this involves proactive practices that create opportunities for all people, particularly those experiencing the most marginalization, to become involved in systemic health-care decision-making. A system that is responsive to the needs of the most marginalized will ultimately work better for all people.
Who you are, how you look, where you live and how much money you make should never be the difference between life and death. Let us commit to a future in which all people have the resources and support to prevent and treat cancer so that no one is left behind.
This article is republished from HealthyDebate under a Creative Commons license. Read the original article.
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Scarcity Brain – by Michael Easter
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After a brief overview of theevolutionary psychology underpinnings of the scarcity brain, the author grounds the rest of this book firmly in the present. He explains how the scarcity loop hooks us and why we crave more, and what factors can increase or lessen its hold over us.
As for what things we are wired to consider “potentially scarce any time now” no matter how saturated we are in them, he looks at an array of categories, each with their nuances. From the obvious such as “food” and “stuff“, to understandable “information” and “happiness“, to abstractions like “influence“, he goes to many sources—experts of various kinds from around the world—to explore how we can know “how much is enough”, and—which can be harder—act accordingly.
The key, he argues, is not in simply wanting less, but in understanding why we crave more in the first place, get rid of our worst habits, and use what we already have, better.
Bottom line: if you feel a gnawing sense of needing more “to be on the safe side”, this book can help you to be a little more strategic (and at the same time, less stressed!) about that.
Click here to check out Scarcity Brain, and manage yours more mindfully!
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In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital
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McALESTER, Okla. — It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.
Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.
It’s a payday the hospital and Hackler have shared frequently over the past three decades, records show. The records indicate McAlester Regional Medical Center and an affiliated clinic have filed close to 5,000 debt collection cases since the early 1990s, most often represented by the father-daughter law firm of Hackler & Hackler.
Some of McAlester’s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.
“There’s a lot that’s not right,” Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said turned out to be vertigo.
In recent years, major health systems in Virginia, North Carolina, and elsewhere have stopped suing patients following news reports about lawsuits. And several states, such as Maryland and New York, have restricted the legal actions hospitals can take against patients.
But with some 100 million people in the U.S. burdened by health care debt, medical collection cases still clog courtrooms across the country, researchers have found. In places like McAlester, a hospital’s debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to limit hospital lawsuits failed in the Oklahoma Legislature in 2021.
In McAlester, the lawsuits have provided business for some, such as the Adjustment Bureau, a local collection agency run out of a squat concrete building down the street from the courthouse, and for Hackler, a former president of the McAlester Area Chamber of Commerce. But for many patients and their families, the lawsuits can take a devastating toll, sapping wages, emptying retirement accounts, and upending lives.
McKee said she wasn’t sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.
“This affects a large number of people in a small community,” said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. “The impact is great.”
Settled more than a century ago by fortune seekers who secured land from the Choctaw Nation to mine coal in the nearby hills, McAlester was once a boom town. Vestiges of that era remain, including a mammoth, 140-foot-tall Masonic temple that looms over the city.
Recent times have been tougher for McAlester, now home by one count to 12 marijuana dispensaries and the state’s death row. The downtown is pockmarked by empty storefronts, including the OKLA theater, which has been dark for decades. Nearly 1 in 5 residents in McAlester and the surrounding county live below the federal poverty line.
The hospital, operated by a public trust under the city’s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor’s website.
“I’m trying to find ways to get the entire community better care and more care,” said Shawn Howard, the hospital’s chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital’s physical therapy department. “This is my hometown,” he said. “I am not trying to keep people out of getting care.”
The hospital operates a clinic for low-income patients, whose webpage notes it has “limited appointments” at no cost for patients who are approved for aid. But data from the audits shows the hospital offers very little financial assistance, despite its purported mission to serve the community.
In the 2022 fiscal year, it provided just $114,000 in charity care, out of a total operating budget of more than $100 million, hospital records show. Charity care totaling $2 million or $3 million out of a $100 million budget would be more in line with other U.S. hospitals.
While audits show few McAlester patients get financial aid, many get taken to court.
Renee Montgomery, the city treasurer in an adjoining town and mother of a local police officer, said she dipped into savings she’d reserved for her children and grandchildren after the hospital sued her last year for more than $5,500. She’d gone to the emergency room for chest pain.
Dusty Powell, a truck driver, said he lost his pickup and motorcycle when his wages were garnished after the hospital sued him for almost $9,000. He’d gone to the emergency department for what turned out to be gastritis and didn’t have insurance, he said.
“Everyone in this town probably has a story about McAlester Regional,” said another former patient who spoke on the condition she not be named, fearful to publicly criticize the hospital in such a small city. “It’s not even a secret.”
The woman, who works at an Army munitions plant outside town, was sued twice over bills she incurred giving birth. Her sister-in-law has been sued as well.
“It’s a good-old-boy system,” said the woman, who lowered her voice when the mayor walked into the coffee shop where she was meeting with KFF Health News. Now, she said, she avoids the hospital if her children need care.
Nationwide, most people sued in debt collection cases never challenge them, a response experts say reflects widespread misunderstanding of the legal process and anxiety about coming to court.
At the center of the McAlester hospital’s collection efforts for decades has been Hackler & Hackler.
Donald Hackler was city attorney in McAlester for 13 years in the ’70s and ’80s and a longtime member of the local Lions Club and the Scottish Rite Freemasons.
Daughter Deborah Hackler, who joined the family firm 30 years ago, has been a deacon at the First Presbyterian Church of McAlester and served on the board of the local Girl Scouts chapter, according to the McAlester News-Capital newspaper, which named her “Woman of the Year” in 2007. Since 2001, she also has been a municipal judge in McAlester, hearing traffic cases, including some involving people she has sued on behalf of the hospital, municipal and county court records show.
For years, the Hacklers’ debt collection cases were often heard by Judge James Bland, who has retired from the bench and now sits on the hospital board. Bland didn’t respond to an inquiry for interview.
Hackler declined to speak with KFF Health News after her recent court appearance. “I’m not going to visit with you about a current client,” she said before leaving the courthouse.
Howard, the hospital CEO, said he couldn’t discuss the lawsuits either. He said he didn’t know the hospital took its patients to court. “I had to call and ask if we sue people,” he said.
Howard also said he didn’t know Deborah Hackler. “I never heard her name before,” he said.
Despite repeated public records requests from KFF Health News since September, the hospital did not provide detailed information about its financial arrangement with Hackler.
McAlester Mayor John Browne, who appoints the hospital’s board of trustees, said he, too, didn’t know about the lawsuits. “I hadn’t heard anything about them suing,” he said.
At the century-old courthouse in downtown McAlester, it’s not hard to find the lawsuits, though. Every month or two, another batch fills the docket in the small-claims court, now presided over by Judge Brian McLaughlin.
After court recently, McLaughlin, who is not from McAlester, shook his head at the stream of cases and patients who almost never show up to defend themselves, leaving him to issue judgment after judgment in the hospital’s favor.
“All I can do is follow the law,” said McLaughlin. “It doesn’t mean I like it.”
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Blood and Water
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Q&A with the 10almonds Team
Q: I really loved the information about macular degeneration! I was wondering if you have any other advice about looking after eye health?
A: We may well do a full feature on it sometime! Meanwhile, some top tips include:
- Eat your greens (as you know from this last Tuesday’s edition of 10almonds)!
- Exercise! Generally. We’re not talking about eye exercises here, we’re talking about exercises that will support:
- Healthy heart rate
- Healthy blood pressure
- Healthy blood oxygenation
- Healthy blood sugar levels
- Healthy blood flow in general (so keep hydrated too! There’s a reason phlebotomists ask you to be well-hydrated before they take blood)
Eye health is a good indicator for a lot of other things, and that’s because whether or not the eyes are the window to your soul, they’re definitely the window to what your blood’s like, and that affects (and is affected by) so many other things.
- On that note, don’t smoke!
- Protect your eyes physically, too. This means:
- UV-blocking sunglasses when appropriate
- Protective eye-wear when appropriate
You think safety glasses are for laboratories and construction sites, then you go and do comparable tasks in your home? Your eyes are just as damageable in your kitchen or garden as they would be in a lab or workshop.
Some bits and bobs that can help:
- Safety sunglasses! Because a thing can do two jobs (useful in the garden now the days are brightening up!)
- Pulse oximeter! Check your own heart rate, pulse strength, and blood oxygenation at home!
- Blood pressure monitor! Because it’s so important for a lot of things and you really should have one.
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Top 10 Early Warning Signs Of Dementia
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What’s a harmless momentary mind-blank, and what’s a potential warning sign of dementia? Dementia Careblazers, a dementia care organization, has input:
The signs
With the caveat that this is a list of potential warning signs, not a diagnostic tool, the 10 signs are:
- Memory loss: e.g. forgetting important or well-learned information, such as one’s home address
- Challenges in planning or solving problems: e.g. difficulty with tasks such as paying bills (for organizational rather than financial reasons), following recipes, or managing medications
- Difficulty completing familiar tasks: e.g. trouble remembering rules of a familiar game, or directions to a familiar place
- Confusion with place or time: e.g. forgetting where one is, or making mistakes with the date, season, or other time-related details. Note that anyone can be momentarily unsure of today’s date, but if someone thinks it’s 1995, probably something wrong is not quite right. Similarly, being wrong about who is the current national leader is often used as a test, too—assuming countries with enough political stability to not have five different national leaders in the past four years, including one who did not outlast a lettuce *side-eyeing the UK*
- Trouble understanding visual images and spatial relationships: e.g. increased clumsiness, difficulty parking, or bumping into objects
- New problems with speaking or writing: e.g. losing track in conversations, or struggling to find the right words
- Misplacing things: e.g. losing items and being unable to retrace one’s steps to find them
- Decreased or poor judgment: e.g. falling for scams, giving out too much information or money without investigating appropriately first
- Withdrawal from social activities or hobbies: e.g. losing interest in activities one used to enjoy or avoiding social interactions
- Changes in mood and personality: e.g. increased irritability, anxiety, or other noticeable changes in behavior and personality
For more information on each of these, enjoy:
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Want to learn more?
You might also like to read:
Dementia: Spot The Signs (Because None Of Us Are Immune)
Take care!
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10 Oft-Ignored Symptoms Of Diabetes
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Due in part to its prevalence and manageability, diabetes is often viewed as more of an inconvenience than an existential threat. While very few people in countries with decent healthcare die of diabetes directly (such as by diabetic ketoacidosis, which is very unpleasant, and happens disproportionately in the US where insulin is sold with a 500%–3000% markup in price compared to other countries), many more die of complications arising from comorbidities, and as for what comorbidities come with diabetes, well, it increases your risk for almost everything.
So, while for most people diabetes is by no means a death sentence, it is something that means you’ll now have to watch out for pretty much everything else too. On which note, Dr. Siobhan Deshauer is here with things to be aware of:
More than your waistline
Some of these are early symptoms (even appearing in the prediabetic stage, so can be considered an early warning for diabetes), some are later risks (it’s unlikely you’ll lose your feet from diabetic neuropathy complications before noticing that you are diabetic), but all and any of them are good reason to speak with your doctor sooner rather than later:
- Polyuria: waking up multiple times at night to urinate due to excess glucose spilling into the urine.
- Increased thirst: dehydration from frequent urination leads to excessive thirst, creating a cycle.
- Acanthosis nigricans: dark, velvety patches on areas like the neck, armpits, or groin, signalling insulin resistance.
- Skin tags: multiple skin tags in areas of friction may indicate insulin resistance.
- Recurrent Infections: high blood sugar weakens the immune system, making skin infections, UTIs, and yeast infections more common.
- Diabetic stiff hand syndrome: stiffness in hands, limited movement, or a “positive prayer sign” caused by sugar binding to skin and tendon proteins.
- Frozen shoulder and trigger finger: pain and limited movement in the shoulder or fingers, with a snapping sensation when moving inflamed tendons.
- Neuropathy: numbness, tingling, or pain in hands and feet due to nerve and blood vessel damage, often leading to foot deformities like Charcot foot.
- Diabetic foot infections: poor sensation, weakened immune response, and slow healing can result in severe infections and potential amputations.
- Gastroparesis: damage to stomach nerves causes delayed digestion, leading to bloating, nausea, and erratic blood sugar levels.
For more on all of these, plus some visuals of the things like what exactly is a “positive prayer sign”, enjoy:
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Want to learn more?
You might also like to read:
Cost of Insulin by Country 2024 ← after the US, the next most expensive country is Chile, at around 1/5 of the price; the cheapest listed is Turkey, at around 1/33 of the price.
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The Biggest Cause Of Back Pain
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Will Harlow, specialist over-50s physiotherapist, shares the most common cause (and its remedy) in this video:
The seat of the problem
The issue (for most people, anyway) is not in the back itself, nor the core in general, but rather, in the glutes. That is to say: the gluteus maximus, medius, and minimus. They assist in bending forwards (collaborating half-and-half with your back muscles), and help control pelvic alignment while walking.
Sitting for long periods weakens the glutes, causing the back to overcompensate, leading to pain. So, obviously don’t do that, if you can help it. Weak glutes shift the work to your back muscles during bending and walking, increasing strain and—as a result—back pain.
The solution (besides “sit less”) is to do specific exercises to strengthen the glutes. When you do, focus on good form and do not try to push through pain. If the exercises themselves all cause pain, then stop and consult a local physiotherapist to figure out your next step.
With that in mind, the five exercises recommended in this video to strengthen glutes and reduce back pain are:
- Hip abduction (isometric): use a heavy resistance band or belt around legs above the knees, push outwards.
- The clam: lie on your side, bend your knees 90°, and lift your top knee while keeping your body forward. Focus on glute engagement.
- Clam with resistance band: use a light resistance band above your knees and perform the same clam exercise.
- Hip abduction (straight leg): lie on your side, keep legs straight, lift your top leg diagonally backward. Lead with your heel to target your glutes and avoid back strain.
- Hip abduction with resistance band: place a resistance band around your ankles, and lift leg as in the previous exercise.
For more on all these, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- 6 Ways To Look After Your Back
- Strong Curves: A Woman’s Guide To Building A Better Butt And Body – by Bret Contreras & Kellie Davis
- How To Stop Pain From Spreading
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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