Go Lean…Caribbean

Go Lean Commentary:

The subject in the foregoing news article just cannot be ignored: Climate Change and personal health.

While this report was published by undisputed technocratic professionals, the Children’s Hospital of Philadelphia (CHOP), the publishers of the book Go Lean…Caribbean had engaged a similar analysis methodology: assessments based on hard evidence – number crunching (Big Data) and anecdotes – to reach their conclusions in the book that the Caribbean is in a state of crisis.

Both analyses are now aligned!

This subject of damaging health effects deriving from Climate Change aligns with Go Lean … Caribbean, as it posits that there are agents of change, including Climate Change, that the region is struggling to contend with, and that the negative consequences are already manifesting themselves in everyday Caribbean life, but the region as a whole and individual member-states, are not able, willing or equipped to mitigate the associated risks. The book portrays that the appropriate response requires heavy-lifting, and therefore proposes the Caribbean Union Trade Federation (CU) as a technocratic solution. The book serves as a roadmap for the introduction and implementation of the CU. This Go Lean roadmap describes the CU as the best solution for a concerted Caribbean response.

The CHOP research is published as follows:

CHOP-Led Research Finds Link between Hotter Days, Kidney Stones in U.S. Adults and Children
Contact: Ashley Moore, The Children’s Hospital of Philadelphia, 267-426-6071 or MooreA1@email.chop.edu

As daily temperatures increase, so does the number of patients seeking treatment for kidney stones. In a study that may both reflect and foretell a warming planet’s impact on human health, a research team found a link between hot days and kidney stones in 60,000 patients in several U.S. cities with varying climates.

“We found that as daily temperatures rise, there is a rapid increase in the probability of patients presenting over the next 20 days with kidney stones,” said study leader Gregory E. Tasian, MD, MSc, MSCE, a pediatric urologist and epidemiologist at The Children’s Hospital of Philadelphia (CHOP), who is on the staff of the Hospital’s Kidney Stone Crenter as well as the Hospital’s Center for Pediatric Clinical Effectiveness (CPCE).

Tasian, senior author Ron Keren, MD, MPH, also of CHOP and CPCE, and colleagues from other centers published their results today in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences. The Urologic Diseases in America Project, supported by the National Institute of Diabetes and Digestive and Kidney Diseases, sponsored the study.

The study team analyzed medical records of more than 60,000 adults and children with kidney stones between 2005 and 2011 in Atlanta, Chicago, Dallas, Los Angeles and Philadelphia, in connection with weather data. Tasian and colleagues described the risk of stone presentation for the full range of temperatures in each city. As mean daily temperatures rose above 50 F (10 C), the risk of kidney stone presentation increased in all the cities except Los Angeles. The delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days.

Link between kidney stones and high temperatures
“These findings point to potential public health effects associated with global climate change,” said Tasian. “However,” cautions Tasian, “although 11 percent of the U.S. population has had kidney stones, most people have not. It is likely that higher temperatures increase the risk of kidney stones in those people predisposed to stone formation.” Higher temperatures contribute to dehydration, which leads to a higher concentration of calcium and other minerals in the urine that promote the growth of kidney stones.

A painful condition that brings half a million patients a year to U.S. emergency rooms, kidney stones have increased markedly over the world in the past three decades. While stones remain more common in adults, the numbers of children developing kidney stones have climbed at a dramatically high rate over the last 25 years. The factors causing the increase in kidney stones are currently unknown, but may be influenced by changes in diet and fluid intake. When stones do not pass on their own, surgery may be necessary.

The study team also found that very low outdoor temperatures increased the risk of kidney stones in three cities: Atlanta, Chicago and Philadelphia. The authors suggest that as frigid weather keeps people indoors more, higher indoor temperatures, changes in diet and decreased physical activity may raise their risk of kidney stones.

The researchers argue that the number of hot days in a given year may better predict kidney stone risk than the mean annual temperature. Atlanta and Los Angeles share the same annual temperature (63 F, or 17 C), but Atlanta has far more hot days than Los Angeles, along with nearly twice the prevalence of kidney stones.

Tasian added that while the five U.S. cities have climates representative of those found throughout the world, future studies should explore how generalizable the current findings are. Other studies should analyze how risk patterns vary in different populations, including among children, represented by a small sample size in the current study.

Global warming trend and kidney stone prevalence
The study’s broader context is in patterns of global warming. The authors note that other scientists have reported that overall global temperatures between 2000 and 2009 were higher than 82 percent of temperatures over the past 11,300 years. Furthermore, increases in greenhouse gas emissions are projected to raise earth’s average temperatures by 2 to 8 F (1 to 4.5 C) by 2100. “Kidney stone prevalence has already been on the rise over the last 30 years, and we can expect this trend to continue, both in greater numbers and over a broader geographic area, as daily temperatures increase,” concluded Tasian. “With some experts predicting that extreme temperatures will become the norm in 30 years, children will bear the brunt of climate change.”

More information:
Funds from the National Institutes of Health (grants HD060550 and DK70003), supported this study, along with a research fellowship from the Medical Research Council, U.K. In addition to their CHOP titles, Tasian and Keren are on the faculty of the Perelman School of Medicine at the University of Pennsylvania.

Co-authors of the study are Christopher Saigal, MD, MPH, of UCLA who is a co-principal investigator of the Urologic Diseases in America Project; Antonio Gasparrini, PhD, of the London School of Hygiene and Tropical Medicine; Benjamin Horton, PhD, of Rutgers University; Rodger Madison, MA, of the RAND Corporation; and Jose Pulido, MD, and J. Richard Landis, PhD, both of the University of Pennsylvania.

Taisan GE et al, “Daily Mean Temperature and Clinical Kidney Stone Presentation in Five U.S. Metropolitan Areas: A Time Series Analysis,” Environmental Health Perspectives, published July 10, 2014.
Children’s Hospital of Philadelphia Web Site – Retrieved 07-28-2014
http://www.chop.edu/news/climate-change-may-bring-more-kidney-stones.html

Considering the evidence published in the foregoing article, this is the immediate response that comes to mind:

It is what it is!

While there continues to be deniers and detractors of Climate Change, these first responders treating the ailments in hospitals do not have the luxury of “burying their head in the sand”, especially when a suffering patient (many times a child) is begging for relief. They must simply provide care and count the tally later. The foregoing article is that tally.

Debate over!

The same applies to the Caribbean. The region is arguably the best address on the planet, but there are constant climate-driven threats, especially during the annual hurricane seasons. After each storm’s landfall, there are repercussions and consequences in which commerce systems get disrupted and economic engines are curtailed. The end result, after consistent periods of “famine”, many residents seek to flee because of these challenging economic conditions.

Something is clearly wrong climate-wise and must be addressed. According to the foregoing article, patients (including children) in the United States are not spared from Climate Change. The Caribbean is not spared either. While the Caribbean itself cannot unilaterally fix the problems of Climate Change, we can better prepare for the negative consequences:

Respond
Rebuild
Recover

The Go Lean roadmap specifies where we are as a region (losing 70% brain drain among the college educated; no preparation for spikes in health crises like kidney stones), where we want to go (elevation of Caribbean society in the homeland for all citizens to dissuade migration and provide public health mitigations) and how we plan to get there – confederating as a Single Market entity. While the Go Lean book strategizes a roadmap for economic empowerment, it clearly relates that healthcare and disaster management are germane to the Caribbean quest for health, wealth and happiness. At the outset of the Go Lean book, in the Declaration of Interdependence (Page 11), these points are pronounced:

i.     Whereas the earth’s climate has undeniably changed resulting in more severe tropical weather storms, it is necessary to prepare to insure the safety and security of life, property and systems of commerce in our geographical region. As nature recognizes no borders in the target of its destruction, we also must set aside border considerations in the preparation and response to these weather challenges.

ix.      Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs. The Federation must proactively anticipate the demand and supply of organ transplantation as developing countries are often exploited by richer neighbors for illicit organ trade.

The Caribbean Union Trade Federation has the prime directive of optimizing the economic, security and governing engines of the region. The foregoing article/VIDEO depicts the Big Data analysis that needs to be performed on behalf of Caribbean society. The roadmap specifies both a Commerce Department (Econometrics) and a Health Department in the Separation-of-Power dictum.

There is also the priority on Research & Development (R&D) placed in the foregoing article. The roadmap describes this focus as a community ethos. Then it goes on to stress that the CU must promote the community ethos that R&D is valuable and must be incentivized for adoption. The following list details additional ethos, strategies, tactics, implementations and advocacies to optimize the region’s health deliveries:

In fact, the foregoing news/VIDEO story depicted analysis administered by the Children’s Hospital of Philadelphia (CHOP).  This institution has undisputed credentials and credibility, being ranked, by US News & World Report magazine, as the #1 Children’s Hospital in the country ^[a]. This recognition means that they, CHOP, must be doing things right!

This is a great model for Caribbean society – we too, must do things right.

Technocratic = doing things right!

The Go Lean roadmap posits that more analysis will emerge as a direct result of the CU prioritization on science, technology, engineering and medical (STEM) activities on Caribbean R&D campuses and educational institutions.

This is the heavy-lifting that the CU is designed to bear. Anyone can be afflicted with kidney stones – a painful disorder. Now, obviously, with indisputable Climate Change, these afflictions are becoming more commonplace; the CU, and all Caribbean institutions, must now do things right. This is the Greater Good.

Download the book Go Lean … Caribbean – now!

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Appendix a – Citation References:

Ranked #1 in the United   States – U.S. News & World Report

An important measure of the quality of children’s hospitals in the U.S. is the yearly rankings provided by a magazine called U.S. News & World Report. For the 2014-15 rankings, the magazine surveyed 183 pediatric centers for data about 10 specialties and asked 150 pediatric specialists in each specialty where they would send the sickest children.

The Children’s Hospital of Philadelphia (CHOP) shared the number one spot on the U.S. News Honor Roll, and ranked in the top four in the nation for every pediatric specialty evaluated.

CHOP was recognized for excellence in the following specialties:

Cancer
Cardiology and Heart Surgery
Diabetes and Endocrinology
Gastroenterology
Orthopedics
Neonatology
Nephrology and Kidney Diseases
Neurology and Neurosurgery
Pulmonology
Urology

Source: The Children’s Hospital of Philadelphia – About Us. Retrieved from http://www.chop.edu/service/international-medicine/international-patient-services/about-chop/home.html