1 00:00:00,270 --> 00:00:02,720 This is Laura Dedo with the Becker's Healthcare Podcast. 2 00:00:03,380 --> 00:00:05,680 I'm thrilled today to be joined by Dr. Lawrence Moss, 3 00:00:05,680 --> 00:00:08,760 president and c e o of Nomura's Children's Health. Dr. Moss, 4 00:00:08,760 --> 00:00:10,360 it's a pleasure to have you on the podcast today. 5 00:00:11,450 --> 00:00:12,960 Thank you, Laura. Pleasure to be here. 6 00:00:13,940 --> 00:00:14,160 Now, 7 00:00:14,160 --> 00:00:18,080 I know you've recently released a new ebook called Finding Health by Looking in 8 00:00:18,080 --> 00:00:20,520 the Right Place. Could you tell us a little bit more about it? 9 00:00:22,590 --> 00:00:26,010 Uh, happy to. I maybe should start with the, 10 00:00:26,070 --> 00:00:31,050 the underlying reason that I wrote this and that's that my continued 11 00:00:31,050 --> 00:00:35,730 observation that in this country we tend to equate health with 12 00:00:35,730 --> 00:00:40,450 medical care and we try to fix problems related to 13 00:00:40,480 --> 00:00:44,650 help by throwing more and more medical care dollars at the problem. 14 00:00:45,470 --> 00:00:50,090 And this book is a response to that and provides my, my point of view, 15 00:00:50,310 --> 00:00:51,850 in fact, not just my point of view, 16 00:00:52,110 --> 00:00:56,850 my observation and statement of the fact that health is mostly 17 00:00:57,030 --> 00:00:57,970 not medical care. 18 00:00:58,470 --> 00:01:02,970 We know from decades of research that health is about 80% 19 00:01:03,620 --> 00:01:08,290 other factors such as food security, safe housing, freedom from violence, 20 00:01:08,520 --> 00:01:12,010 good education, and about 20% medical care. 21 00:01:13,000 --> 00:01:16,970 Nemours is an organization that provides medical care to children. 22 00:01:17,900 --> 00:01:18,733 However, 23 00:01:18,840 --> 00:01:22,870 we're an organization that sees ourselves in the business of creating health, 24 00:01:23,130 --> 00:01:24,790 not just delivering medical care. 25 00:01:24,850 --> 00:01:27,350 And that means getting involved in all of those other things. 26 00:01:29,820 --> 00:01:32,700 Absolutely. That's fascinating and certainly such an important, uh, 27 00:01:32,930 --> 00:01:34,660 area to be focused on right now. 28 00:01:34,820 --> 00:01:38,780 I can imagine that there are so many different health issues that your patient 29 00:01:38,780 --> 00:01:41,620 population is going through, especially coming out of the pandemic. 30 00:01:42,300 --> 00:01:46,460 I know that the book subtitle is how understanding what actually Creates Health 31 00:01:46,600 --> 00:01:48,380 Can Fix U US healthcare. 32 00:01:48,550 --> 00:01:51,900 Could you tell us a little bit more about what that means in what really, uh, 33 00:01:51,900 --> 00:01:55,260 you're getting at with some of the, these big themes and topics of the book? 34 00:01:57,260 --> 00:01:58,093 Uh, of course. 35 00:01:58,340 --> 00:02:03,240 Let me start with a bit of a personal perspective or a personal 36 00:02:03,330 --> 00:02:07,680 story. Um, by training, before I became CEO of Nemours, 37 00:02:07,780 --> 00:02:12,520 I'm an academic pediatric surgeon and I spent my career for 25 38 00:02:12,580 --> 00:02:14,200 or 30 years prior to this role, 39 00:02:14,860 --> 00:02:19,600 taking care of kids with extraordinarily complex problems including 40 00:02:19,670 --> 00:02:22,960 complex congenital anomalies, advanced cancer, things like that. 41 00:02:23,220 --> 00:02:27,840 So call that the 1% of the 1% in that 42 00:02:27,840 --> 00:02:30,840 aspect of healthcare, or I should say medical care, 43 00:02:31,310 --> 00:02:33,360 this country does extraordinarily well. 44 00:02:33,380 --> 00:02:36,880 And if you're unfortunate enough to have a child with those kind of problems, 45 00:02:36,990 --> 00:02:41,160 this is hands down the place on the planet you wanna be. However, 46 00:02:41,460 --> 00:02:46,200 if you're the other 99.9% looking for health that 47 00:02:46,200 --> 00:02:48,360 doesn't need complex, tertiary quaternary care, 48 00:02:48,550 --> 00:02:51,680 this is arguably the worst place on the planet to be. 49 00:02:51,740 --> 00:02:53,320 Or at least in the developed world, 50 00:02:54,180 --> 00:02:58,720 the United States spends a massive amount on medical care, however, 51 00:02:58,860 --> 00:03:02,380 we have among the worst health illnesses of any developed country. 52 00:03:03,440 --> 00:03:07,540 And we tend to say, oh, that's because healthcare is so complicated. 53 00:03:08,330 --> 00:03:12,940 This book is an effort to demonstrate that health and the pathway 54 00:03:13,160 --> 00:03:15,140 to health is not that complicated. 55 00:03:15,360 --> 00:03:19,980 It actually includes things that all of us are familiar with and all of us 56 00:03:19,980 --> 00:03:21,980 experience in our lives every day. 57 00:03:22,320 --> 00:03:25,860 And that is really the core message I wanted to send to people. 58 00:03:27,640 --> 00:03:30,820 That's such an important message and so interesting to hear, um, 59 00:03:30,830 --> 00:03:35,300 about just really being able to dig deep into these challenges and really 60 00:03:35,350 --> 00:03:40,220 understand and, um, decompress some of the, the big issues in healthcare today. 61 00:03:40,220 --> 00:03:41,053 And I'm wondering, 62 00:03:41,280 --> 00:03:45,140 is this just a healthcare industry problem or are there roles for other sectors 63 00:03:45,160 --> 00:03:47,340 to really pitch in and be part of the solution? 64 00:03:47,430 --> 00:03:48,940 Could you talk through that a bit more? 65 00:03:50,700 --> 00:03:52,190 Well, great question. No, 66 00:03:52,190 --> 00:03:56,310 it's not just a healthcare industry problem and frankly it's not a healthcare 67 00:03:56,590 --> 00:03:59,990 industry problem. It's a more global problem than that. Now, 68 00:04:00,030 --> 00:04:04,750 I like to say that fixing healthcare in the United States is not complicated at 69 00:04:04,750 --> 00:04:09,670 all. It's actually quite simple and we just need to do three things. Number one, 70 00:04:10,160 --> 00:04:11,590 understand what health is. 71 00:04:12,370 --> 00:04:17,150 And that's about realizing that health is 80% not medical care and realizing 72 00:04:17,150 --> 00:04:22,110 that we need to get involved in those things. Number two, pay for health. 73 00:04:23,230 --> 00:04:24,170 In the United States, 74 00:04:24,790 --> 00:04:29,690 our healthcare enterprise is a roughly 4.1 trillion per year entity. 75 00:04:29,690 --> 00:04:34,490 And almost every penny of that goes to the opposite of what we 76 00:04:34,490 --> 00:04:39,030 want, which is health. We don't pay for health in this country. 77 00:04:39,170 --> 00:04:43,710 We pay for volume of medical care delivered and complexity of medical care 78 00:04:43,710 --> 00:04:46,790 delivered. Therefore we get what we pay for. 79 00:04:46,970 --> 00:04:49,750 We deliver more than any other nation on earth. 80 00:04:50,170 --> 00:04:54,270 We charge more than any other nation on earth, and we get, 81 00:04:54,450 --> 00:04:58,390 and that's exactly what we get is an awful lot of medical care delivered and not 82 00:04:58,390 --> 00:05:03,030 health. And finally, bullet number three is start with children. 83 00:05:03,770 --> 00:05:08,550 And I think it's important for society to realize that children's health care 84 00:05:08,730 --> 00:05:11,310 is not only about children's health, 85 00:05:11,980 --> 00:05:16,870 it's about the health of our entire society and the roots of all 86 00:05:16,870 --> 00:05:20,750 of the problems that we deal with in our adult population. Cancer, 87 00:05:20,760 --> 00:05:24,030 heart disease, diabetes, poor workforce, productivity, 88 00:05:24,650 --> 00:05:29,510 all of those start in childhood and can be addressed far more effectively 89 00:05:29,630 --> 00:05:33,070 in childhood than they can after the horse is out of the barn. 90 00:05:34,370 --> 00:05:38,110 That's such a great point and so important to keep in mind as we're thinking 91 00:05:38,110 --> 00:05:42,030 about the global healthcare crisis and especially the healthcare system in the 92 00:05:42,030 --> 00:05:46,230 United States. I know the pediatric population certainly gets overlooked, um, 93 00:05:46,320 --> 00:05:49,630 quite often, but as you mentioned, it's, you know, those, uh, 94 00:05:49,630 --> 00:05:52,670 health issues and habits and, and all sorts of other things, um, 95 00:05:52,670 --> 00:05:56,150 really can make a big difference if you're starting as a child. And you know, 96 00:05:56,630 --> 00:06:00,260 I know too that you have a chapter on health and transportation within the book. 97 00:06:00,520 --> 00:06:03,820 What's the connection there and how can transportation issues, uh, 98 00:06:03,820 --> 00:06:05,300 bring about changes in health? 99 00:06:07,790 --> 00:06:12,730 So transportation might sound like kind of an esoteric issue that's 100 00:06:12,970 --> 00:06:17,330 somewhat distant from health, but actually it's directly related to health. 101 00:06:18,070 --> 00:06:19,890 Um, in a most obvious way, 102 00:06:21,130 --> 00:06:24,710 nobody can get medical care unless they can get to the appointment in the first 103 00:06:24,710 --> 00:06:29,110 place. And that is an enormous burden for a huge proportion of our population. 104 00:06:30,890 --> 00:06:35,650 Children in the United States have their medical care funded by 105 00:06:36,690 --> 00:06:38,810 Medicaid in 54% of cases, 106 00:06:38,980 --> 00:06:43,370 which means the majority of children in the United States come from 107 00:06:43,610 --> 00:06:46,610 economically limited circumstances. And in that population, 108 00:06:46,870 --> 00:06:48,970 transportation can be a huge issue, 109 00:06:49,910 --> 00:06:54,650 but the issue of of less than optimal access to transportation 110 00:06:54,840 --> 00:06:58,530 goes far beyond simply being able to get to medical appointments. 111 00:06:59,150 --> 00:07:01,370 It relates to being able to get to school, 112 00:07:01,740 --> 00:07:05,290 being able to get to a supermarket where there's fresh and healthy food, 113 00:07:05,540 --> 00:07:07,170 being able to get to daycare, 114 00:07:07,770 --> 00:07:11,690 a parent being able to get back and forth to work and maintain employment. 115 00:07:12,350 --> 00:07:17,330 So transportation runs pretty deep when we talk 116 00:07:17,330 --> 00:07:21,030 about health, not just medical care. 117 00:07:23,120 --> 00:07:23,420 Got it. 118 00:07:23,420 --> 00:07:26,460 That's such an important point and definitely makes sense when you talk through 119 00:07:26,460 --> 00:07:29,780 it that way. I, I really appreciate your expertise in, in such a, 120 00:07:29,820 --> 00:07:32,940 a great perspective to have. Now I know another chapter, 121 00:07:33,160 --> 00:07:36,340 you talk about nutrition having supernatural effects. 122 00:07:36,760 --> 00:07:38,020 In what way does that occur? 123 00:07:40,330 --> 00:07:44,340 Nutrition in many, many ways is really the root of health. 124 00:07:44,880 --> 00:07:48,700 And when there are nutritional problems in early childhood 125 00:07:49,610 --> 00:07:53,420 that subsequently leads to obesity, 126 00:07:53,840 --> 00:07:58,620 to diabetes, to heart disease, to a higher risk for cancer, frankly, 127 00:07:58,760 --> 00:08:02,500 to almost every adult disease that we see in the population. 128 00:08:03,320 --> 00:08:07,900 And when I talk about children being a lever of impact, 129 00:08:09,600 --> 00:08:14,330 tiny and very inexpensive changes in nutrition and other 130 00:08:14,330 --> 00:08:19,330 areas that happen in early childhood can have profound influences 131 00:08:19,580 --> 00:08:22,810 later in life in health trajectories. You know, 132 00:08:22,810 --> 00:08:27,570 when we look at the profound health problems in our adult population, we can, 133 00:08:27,630 --> 00:08:32,090 and we do spend massively trying to change those health trajectories 134 00:08:32,830 --> 00:08:36,970 and we spend a massive amount for a little bit of effect 135 00:08:37,710 --> 00:08:38,610 in early childhood. 136 00:08:39,430 --> 00:08:43,450 We can spend a tiny amount for a huge effect 137 00:08:44,970 --> 00:08:46,510 as a society. We'll, 138 00:08:46,970 --> 00:08:51,830 we will readily spend a million bucks trying to change the trajectory of a 139 00:08:51,830 --> 00:08:56,820 group of people with diabetes when a hundred bucks in early childhood could be 140 00:08:56,920 --> 00:08:58,140 far, far more effective. 141 00:09:00,910 --> 00:09:05,570 That's fascinating to hear and definitely such an interesting point by you and, 142 00:09:05,710 --> 00:09:09,610 and certainly I, I love that narrative and analysis in looking at how, 143 00:09:09,660 --> 00:09:13,130 especially for kids with diabetes, it makes a really big difference in, 144 00:09:13,230 --> 00:09:16,210 in I'm sure many other, um, health issues as well. 145 00:09:16,730 --> 00:09:20,210 I know many of the areas that you described are areas in which adult and 146 00:09:20,410 --> 00:09:22,730 children can protect their health. Is that true? 147 00:09:22,950 --> 00:09:26,530 Are there differences in how things can impact children as compared to adults? 148 00:09:29,240 --> 00:09:32,450 Well, sure there are differences and children have some, uh, 149 00:09:32,830 --> 00:09:37,090 susceptibilities that are, that are not relevant to the adult population, 150 00:09:37,410 --> 00:09:38,243 although, you know, 151 00:09:38,250 --> 00:09:41,810 I would put those issues as far down the list and relatively minor. 152 00:09:42,350 --> 00:09:47,010 The overarching issue is doing the simple thing 153 00:09:47,760 --> 00:09:51,890 that ensure good health and a good health trajectory in children 154 00:09:53,160 --> 00:09:55,090 pays dividends. You know, I've, 155 00:09:55,090 --> 00:09:57,650 I've never met an adult who didn't used to be a child. 156 00:09:57,870 --> 00:10:02,650 So even though children are 15% of the population and even though they 157 00:10:03,010 --> 00:10:06,530 represent only 7% of the nation's healthcare expenditures, 158 00:10:08,260 --> 00:10:10,990 they ultimately are the key to making changes, 159 00:10:12,070 --> 00:10:16,190 profound changes across society. When we make changes in childhood, 160 00:10:16,790 --> 00:10:21,630 trajectories are changed and all we have to do is wait until those 161 00:10:21,630 --> 00:10:25,990 kids grow up and that becomes the adult population. And even more, 162 00:10:25,990 --> 00:10:30,190 there's the added benefit and we've seen this with experimental evidence that 163 00:10:30,620 --> 00:10:34,630 when we change health behaviors and health beliefs early in childhood, 164 00:10:35,280 --> 00:10:36,630 those kids grow up, 165 00:10:36,690 --> 00:10:40,870 become adults and pass those behaviors onto their children 166 00:10:41,300 --> 00:10:43,470 without any further intervention from us. 167 00:10:43,570 --> 00:10:45,830 So it's an enduring and pervasive impact. 168 00:10:48,120 --> 00:10:51,760 I see your point. That um, definitely makes a lot of sense. And you know, 169 00:10:51,840 --> 00:10:55,440 I can imagine being able to reach children effectively takes a, 170 00:10:55,480 --> 00:10:58,520 a real group effort, a village if you will, um, 171 00:10:58,710 --> 00:11:02,400 from the parents to the caregivers to the community and then the health system. 172 00:11:02,900 --> 00:11:06,920 Um, for the hospital and health system leaders who are listening to this podcast 173 00:11:07,090 --> 00:11:11,720 today, what is most effective for them? How can they really influence, um, 174 00:11:11,720 --> 00:11:15,160 and impact the children within their community most effectively? 175 00:11:16,890 --> 00:11:20,540 Well, I'll speak to my peers in the children's hospital industry cuz I think the 176 00:11:20,540 --> 00:11:22,980 issues may be a little bit different for adult hospitals, 177 00:11:23,160 --> 00:11:27,940 but I believe very strongly that children's hospitals need to 178 00:11:27,940 --> 00:11:31,460 become the stewards of children's health in this country. 179 00:11:32,160 --> 00:11:36,060 Not just the place sick children go for medical care will always be the place 180 00:11:36,060 --> 00:11:37,820 where sick children go for medical care. 181 00:11:38,240 --> 00:11:42,780 But our obligation and our opportunity is so much greater than that now. 182 00:11:43,080 --> 00:11:47,660 We are experts at delivering medical care. We're not experts in housing, 183 00:11:48,090 --> 00:11:48,923 food, security, 184 00:11:49,090 --> 00:11:53,560 education and all those other factors that predominantly determine health. 185 00:11:53,770 --> 00:11:54,603 However, 186 00:11:54,680 --> 00:11:59,660 we can be the conveners of experts in those areas that bring everybody 187 00:11:59,940 --> 00:12:03,340 together to do what you say takes a village, 188 00:12:03,430 --> 00:12:08,240 which is create a healthy trajectory for all children in this country. 189 00:12:10,720 --> 00:12:13,230 Thank you so much for, for describing that for us. 190 00:12:13,510 --> 00:12:17,310 I think that's so helpful and definitely, um, is important for all, uh, 191 00:12:17,590 --> 00:12:21,750 children's hospitals in particular, but in others to just keep in mind. Finally, 192 00:12:21,750 --> 00:12:22,710 before we wrap up, 193 00:12:22,740 --> 00:12:25,190 what is the main thing you want readers to take away from this book? 194 00:12:27,570 --> 00:12:30,640 Let's keep it simple, Laura. I want people to take away three things. 195 00:12:31,300 --> 00:12:35,560 The prescription to fix healthcare, understand what health is, 196 00:12:36,220 --> 00:12:40,260 pay for health, start with children, and that's it. 197 00:12:41,960 --> 00:12:44,620 Simple, straightforward. I love it. Thank you so much Dr. 198 00:12:44,730 --> 00:12:47,260 Moss for being here today. This has been such a fun conversation. 199 00:12:47,640 --> 00:12:51,340 I'm really excited that you're able to launch this ebook and I know anyone can 200 00:12:51,580 --> 00:12:56,540 download the book for free of charge at http slash slash 201 00:12:56,730 --> 00:12:59,300 nemours.org/ Larry Moss leadership. 202 00:13:01,640 --> 00:13:02,790 Thank you so much, Laura. 203 00:13:02,790 --> 00:13:07,030 It was a privilege to talk with you and I appreciate Becker's interest in the 204 00:13:07,030 --> 00:13:10,070 work that we're doing and we look forward to continuing to contribute to the 205 00:13:10,070 --> 00:13:10,750 health of children.