Butler Calls for Systematic Health Reform for All Ages
Kleyman, Paul, Aging Today
It was 7:30 in the morning one day several years ago in New York City's Central Park, much earlier than my usual hour for vigorous activity. I'd been invited to join Robert N. Butler - Pulitzer Prize winner, first director of the National Institute on Aging, coiner of the term ageism and, currently, president of the International Longevity Center in New York - on one of his five-mile constitutionals. I soon found - as have others on these power walks - that it isn't easy keeping up with the elder statesman of aging.
Fitness, for America's top geriatrician, is more than a personal health matter. As the octogenarian author has been touring the United States to promote his new book, The Longevity Revolution: The Benefits and Challenges of Living a Long Life (Public Affairs, 2008), he has been urging people to get moving.
MORE THAN FITNESS
"We have to move public health and prevention away from just the doctor's office," Butler recently told an authence at the Commonwealth Club in San Francisco. "I think we should have national walking clubs," he told the group. More than a popularizer of fitness activities, though, Butler conveys a deeper message about the challenges of preventing illness and promoting wellness.
Butler stressed that a wellness-oriented system cannot be based mainly in doctors' offices "because most doctors, under the economics of contemporary practice, do not have the kind of time required to be really helpful around tobacco, alcohol and the many problems that emerge related to prevention. I think it has to be a public health.venture."
"We need to have senior centers and community centers begin to include health promotion and disease prevention efforts," he said. For example, senior centers and related locations could help prevent dangerous falls among older people - the 12th cause of death among elders - by teaching older adults very simple exercises to improve their balance and strengthen their thigh muscles.
To develop a preventive approach for all age groups, Butler said, "we really need very simple, inexpensive measures. You shouldn't have to belong to a health club - get out there and walk with a family member, with a friend or with a group. Movement is so critical with regard to weight, aerobic conditioning, the heart, stamina and muscle preservation."
CANDIDATES AND REFORM
Butler emphasized that prevention and health promotion need to be woven into a larger fabric of change in the U.S. healthcare system and commented, "All of our presidential candidates are dealing only so far with the financial aspects of the issue of healthcare. They are not really dealing with the necessary structural reform." Deeper reform, he said, won't happen unless political leaders get beyond "vague statements and [support] a seamless system of care that includes prevention all the way through acute care, chronic care and end-of-life care."
Buder called for changing "perverse" financial incentives in U.S. healthcare, which now pay the highest rates to procedural specialists and the lowest to primary care physicians. He added that only a third of doctors in die United States are in primary care, compared with 50% in Europe. "You can make a lot of money on Botox these days, whereas the primary care doctors, who take care of all of us, are dwindling away," he said.
In addition, Butler observed that although every medical school in Great Britain has a full department of geriatrics, the United States has only 11 among its 145 schools of medicine. He asked, "How do we deal with making sure that we have well-trained people to take care of us as we grow older?"
He continued, "There's very little attention being spent on the training of the workforce. What about nutritionists, what about geriatricians, what about nurses, what about social workers and pharmacists? How well trained are they to be in tune with the reality of die changing character of our population, with growing numbers of older people? …