M-RCBG Senior Fellow-Led Study Group: Camilla Cavendish
Session 1: The power of story in medicine: why patients don't always follow doctors' orders, and the kind of conversations physicians might like to have
With Suzanne Koven MD, primary care physician, writer in residence at Mass General Hospital, and Boston Globe contributor
November 7, 4:00-5:30 M-RCBG Conference Room B-503
Session 2: The Fourth Industrial Revolution: More Diverse, Less Inclusive? Details here
With Trevor Phillips, Chair of the NY Center for Talent Innovation, anti-racism campaigner, former Chair of the UK Equalities Commission
November 27, 4:00-5:30 Nye A (Taubman 520)
Session 3: "An Ounce of Prevention is Worth a Pound of Cure”: but how do we change our health systems? Details here
With guest speaker Thomas J. Croce, Jr., Vice President, Global Advocacy Relations, Amgen Inc
April 24, 4:00-5:30 Darman Seminar Room (Taubman 135)
Overview
The 100-year life is coming: many ĚÇĐÄvlogąŮÍř students will end up living a century. That’s a huge opportunity. But without radical action, too many people will spend their extra years with chronic disease: diabetes, heart problems, dementia. There is a growing gap between rich and poor in terms of life expectancy and healthy life expectancy in Western countries (the poorest can expect to spend 9 more years in poor health than the richest). Even as smoking rates fall, obesity, type-2 diabetes and hypertension are rising.
Tackling those chronic diseases will mean changing our health care systems; reaching across the medical silos and building networks which can interact with patients on a long-term basis; very different to the post-war systems which patched us up and sent us on our way. And it will make effective prevention of disease far more important. Yet Western healthcare systems spend far more on treating disease than preventing it – the ratio is around 10:1 in the US and UK, the Netherlands and Norway, and even lower in Australia. Modern health services were set up to treat disease, not to preserve health – and that’s how they book the financial gains.
Public health is the Cinderella of government policy, the bit which gets cut when funding is tight. It’s easy to quantify the costs of treating the sick, harder to judge the impact of public health interventions to keep people healthy, whose pay-offs are often long term and hard to quantify. Yet some kinds of “social prescribing” are already showing results. At Geisinger’s Fresh Food Farmacy, doctors are prescribing food as medicine. At MIRA Rehab, therapists are using gaming software to help patients improve strength and balance. We know that genomics and AI will improve our ability to predict who is most at risk. Moreover research suggests that doctors can be powerful advocates for simple lifestyle changes – if they want to be.
Session 1: The power of story in medicine: why patients don't always follow doctors' orders, and the kind of conversations physicians might like to have
Senior Fellow Baroness Camilla Cavendish, former senior advisor to UK Prime Minister Cameron and author of the UK government’s soda tax, will be joined by Suzanne Koven MD, primary care physician, writer in residence at Mass General Hospital, and contributor to the Boston Globe, New York Times and eminent journals.
If we want to live a healthy 100 years, we need to start now. Advice is plentiful – a majority of people who are obese claim to be on a diet for example – but it’s not always effective. Increasingly, experts are looking at how to tackle the underlying psychological factors which hold people back. The relationship between patient and physician can have a huge impact: but it is rarely explored.
Dr Koven will draw on her 30 years' experience of interactions with patients, especially with women over 50. She will offer her reflections on physician-patient conversations, what those conversations look like from both sides, and explain why patients don’t always do what the doctor orders. The group will consider the hard choices facing many doctors today, under time pressure; when it is appropriate to provide a pill, and when a deeper exploration of psycho-social factors can be effective in tackling chronic disease.
Pre-reading (useful but not required):
Session 2: The Fourth Industrial Revolution: More Diverse, Less Inclusive?
Senior Fellow Baroness Camilla Cavendish, former senior advisor to UK Prime Minister Cameron, will be joined by Trevor Phillips, Chair of the NY Center for Talent Innovation, Chairman of Green Park, and former Chair of the UK Equalities Commission.
In a 100-year life, we will all need to work longer. But will the Fourth Industrial Revolution help or hinder us? How might the Fourth Industrial Revolution impact the life chances of different protected groups? Will automated processes and intelligent computational systems end up accelerating discrimination?
Trevor Phillips will set out his concerns about these questions, reflect on his experience of fighting for racial and gender equality, and discuss how we might apply some of the lessons to the challenges of the evolving workplace today. He will advance his theory of “complementarity” - based on portfolio share theory – to describe what diverse, successful teams might look like in the era of Big Data and longer life.
The group will examine conflicting evidence about whether diverse teams lead to better performance. We will consider possible approaches to assembling and managing teams which encompass greater diversity, and debate what we have learned so far, from the ongoing battles against sexism and racism. We will conclude with possible next steps to rewrite the conventional career timetable, avoid homogeneity in recruitment, manage diverse workforces and improve opportunity for diverse talent to flourish in the Fourth Industrial Revolution.
Pre-reading (useful but not required)
Session 3: "An Ounce of Prevention is Worth a Pound of Cure”: but how do we change our health systems?
With guest speaker Thomas J. Croce, Jr., Vice President, Global Advocacy Relations, Amgen Inc
April 24, 4:00-5:30 Darman Seminar Room (Taubman 135)
Thomas Croce is a former practicing pharmacist, and now a senior executive at Amgen, the biopharmaceutical company - one of Fast Company’s 2019 “most innovative companies in biotech”. He will argue that health systems need to shift from “break and fix” to “predict and prevent”, drawing on his 15 years’ experience of practice in hospitals and the community. How can we do more, for example, to tackle heart disease earlier? Should we consider providing technology like wearables to employees to track risk factors? Are incentives aligned for a “predict and prevent” system?
Together with Laura Heath, primary care physician and MPH student at the Harvard Graduate School of Public Health, the group will examine evidence for what kinds of behavioural medicine are successfully improving health. We will analyse the barriers to adopting such schemes, and ask whose responsibility is prevention? What can different parts of the medical community, and government do, and what must we as individuals do ourselves? We will discuss the clinical and financial barriers to prevention, and conclude by considering what public policy changes could be made to improve health for all.
Camilla Cavendish is an award-winning journalist and commentator who sits as an independent peer, Baroness Cavendish of Little Venice, in the UK House of Lords. She was a senior advisor to Prime Minister David Cameron, as Head of the Policy Unit in Number Ten Downing Street. She received her MA from Oxford University in Politics, Philosophy and Economics and her MPA from the Kennedy School, where she was a Kennedy Memorial Trust Scholar. She has expertise on a wide-range of policy issues, including healthcare. She was the author of the Cavendish Review, An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings, commissioned by the UK Government in 2013. She has been a Non-Executive Director of the Care Quality Commission, the UK’s hospital and care home regulator. She is best known as the author of the UK government’s “sugar tax” on sugary drinks, announced in 2016 to counter obesity, and for her work on child protection. As Assistant Editor and OpEd columnist for The Times newspaper, her campaign to expose miscarriages of justice in family courts convinced the Brown government to legislate, to open those courts to the media. She is the recipient of the Paul Foot/Private Eye award for investigative journalism; Campaigning Journalist of the Year and Wincott Senior Financial Journalist. She is published regularly in The Sunday Times and The Financial Times, appears regularly on BBC and ITV television, and has presented programmes for BBC Radio 4 on topics including the age divide and air pollution. She is chair of Frontline, a pioneering non-profit which recruits and trains high performing graduates to be social workers. She started her career at McKinsey & Co and went on to be CEO of a public-private joint venture which regenerated London’s south bank area. As a Senior Fellow, her research is entitled: The coming demographic challenge, the emergence of the “Super Old”, and the need for new conceptual frameworks. Her faculty sponsor is Jeff Liebman, Malcolm Wiener Professor of Public Policy. Email: camilla_cavendish@hks.harvard.edu