The following ran on May 26th as a part of CNN Health’s coverage on the empowered patient. It is written by Elizabeth Cohen.

By Elizabeth Cohen. As much as she would like to, Dr. Lissa Rankin, a gynecologist, will never forget the woman who planned her wedding while lying naked on her examining table.

“Every 15 seconds, her cell phone was going off, and she was answering it!” Rankin recalls. “It was like, ‘That’s not the cake I ordered,’ and, ‘No, it’s the other gown,’ and I said to her, ‘Is this a bad time? Should I come back later?’ ”

The bride may have been doing great things for her wedding, but she was sabotaging her own care — and it was a really important visit, as she was newly pregnant.

Talking on your cell phone in the examining room, forgetting what medicines you take and lying to your doctor about your personal health habits are all ways of compromising your health.

“The doctor-patient relationship is like a business partnership,” Rankin says. “We need to work together. Trust me to guide you but be willing to do your part.”

From interviews with a gynecologist, a cardiologist, a rehabilitative medicine specialist, a fertility doctor and an internist, here are the Top 10 things patients do to mess up their own care.

1. You talk on your cell phone.

This is your health we’re talking about. Other calls can wait. Turn the thing off.

2. You lie.

“I need to treat you the best way I can, so if you’re gay, tell me. If you drink a bottle of tequila every night, I need to know. If you’re having an affair and not using condoms, let me know,” says Rankin, who blogs at “Owning Pink.” “I promise I won’t judge you.”

3. You do a sloppy job describing your pain.

Is it stabbing or burning? Sudden or constant? Tingling or hot? The answers will help your doctor make the right diagnosis.

“You should describe the exact location, how intense the pain was, what provoked it and how long it lasted,” says Dr. Nieca Goldberg, director of the New York University Women’s Heart Program.

The week before your appointment, keep a diary of your pain and your other symptoms, too, advises Dr. Loren Fishman, a clinical professor of rehabilitative medicine at Columbia University College of Physicians and Surgeons. He suggests using this time to also think about the questions you want to ask your doctor and what you hope to get out of your appointment. (more…)

Don’t miss out on this year’s Ovarian Cancer National Alliance Annual Conference in Washington, DC, July 9-12! They have an incredible array of speakers and activities planned for their 14th Annual Conference, “Turning Promise Into Action.”

The keynote speaker is Olympic medalist Shannon Miller, who will speak about her battle with ovarian cancer. Ms. Miller was diagnosed with ovarian cancer in early 2011, and has been writing about her journey on her healthy living website.

On Sunday night, you can  rock out with N.E.D., an amazing band dedicated to fighting women’s cancer. This alternative rock band is made up of gynecologic oncologists from around the country. You can hear one of their original songs in this video about OCNA’s 2010 Advocacy Day.

The conference concludes with advocacy visits to Capitol Hill. OCNA will arrange for you to speak with your legislators and their staff about why ovarian cancer matters to you. Please note that you must register separately for Advocacy Day; the registration deadline is June 3.

One of the most poignant moments at each conference is the Remembrance Ceremony commemorating the lives of women lost to ovarian cancer. You can submit original poetry and other remembrances to be included in the ceremony.

Register here. If you have any questions contact Elizabeth White at ewhite@ovariancancer.org or (202) 331-1332.

By Mary Grealy. It wasn’t a head-to-head battle, as such, but Congresswoman Allyson Schwartz (D-PA) squared off against the USA Today editorial board yesterday on the subject of the Independent Payment Advisory Board (IPAB), and I believe the lawmaker clearly made the better arguments.

USA Today’s editorial made the point that the IPAB, created as part of the Affordable Care Act to curb Medicare costs, is essential to do the job that Congress won’t in cutting program spending.  The newspaper compared the new board to the base closing commission that successfully shuttered unneeded military installations.

That’s a dubious argument, though, at best.  The base closing commission carefully studied the value and usefulness of military bases before choosing which ones could be closed without undermining national security.

IPAB will function in a completely different way.  If Medicare spending goes above arbitrary levels, then the board will bring the ax down on program budgets without regard to quality, value or seniors’ access to healthcare.   We’re facing a near future in which the senior population will be rising in number while physicians will be in shorter supply.  Simply cutting provider payments is the wrong answer.

Congresswoman Schwartz, in her response, acknowledged that Medicare costs must be contained, but she wrote that the solution is to reduce costs through innovations in health delivery to “reduce errors, eliminate duplication and waste, use technology to safely share information, and coordinate care between practitioners and settings.” 

She said it best when she wrote, “The threat of reduced payments is the least imaginative option.”  She’s absolutely right, and Washington can and should address the Medicare cost issue more creatively and effectively without diminishing healthcare for those who need it most.

Originally posted on the Prognosis Blog on May 24th.

“What Does Health Reform Do for People on Medicare?” 

The new health reform law benefits people on Medicare in a number of ways. This video explains some of the ways, such as ending out-of-pocket expenses for recommended screenings, checkups and other preventive services, and reducing prescription drug prices in the “doughnut hole.” Featuring John Rother, executive vice president of policy and strategy for AARP.

“Will Health Reform Reduce the Federal Deficit?” 

 The Congressional Budget Office estimates that the health reform law will reduce the federal deficit by $124 billion by 2020. Respected analysts disagree, however. In this video, economist Joe Antos of the American Enterprise Institute explains why he believes health reform will cost much more than expected, primarily because he doubts that future Congresses will go along with the Medicare savings in the Affordable Care Act.

By Robin Strongin. The Centers for Disease Control and Prevention (CDC) proved this week that government communications don’t have to be grey and dull….except from the standpoint that zombies tend to be grey and dull, but I’m getting ahead of myself.

This week, the CDC posted on its Public Health Matters blog a piece entitled “Preparedness 101: Zombie Apocalypse”.  The post emphasized the need for citizens to create an emergency plan in the event of sudden attacks by the walking dead.  These tips included the planning of evacuation routes, making a list of emergency contacts and having supplies like water, non-perishable food items and medications ready to go at a moment’s notice.  As the CDC pointed out on its blog, “When zombies are hungry….you need to get out of town fast!”

Give the creative minds at the CDC a great deal of credit.  By tying valuable information to a fun piece of pop culture, the agency went from its usual 3,000 page views per week to having tens of thousands of web users trying to learn more about zombie apocalypse preparation.  As a result, more Americans now have a better understanding of how to handle real emergencies.

I can’t help thinking that public health needs more of this out-of-the-box thinking.  It wouldn’t hurt to bring some novel ideas to some of our more underutilized programs, like the “Welcome to Medicare” wellness exam, which has been in existence since 2005.  Even though the Medicare population is over 45 million beneficiaries strong, only about 100,000 seniors each year are taking advantage of these physicals for which the federal government is picking up the tab.

We also learned this week from the Reuters health summit that, to quote the lead in the Reuters news story, “Americans are starting to see the doctor again, but more often for cosmetic procedures, such as Botox treatments, rather than cancer screening and other lifesaving preventive care.”

We already knew from previous studies by the RAND Corporation, Robert Wood Johnson Foundation and others that millions of individuals aren’t getting the disease screenings and preventive exams they should.  Perhaps what the CDC has shown us is that these figures can be improved if we make preventive health fun, hip and attention-getting.

I’m thinking there has to be some way to tie blood tests into vampires and the Twilight films, but that may need some work.

By Lois Privor-Dumm. We’ve all heard these words: “There is tremendous need here at home,” or “money in Africa has been wasted for so long.”   This is why this simple video from the ONE campaign struck me. Through a public health lens it is a no-brainer: of course you want to spend on cost–effective interventions that will save lives.  For others, while they admit that it is an admirable goal, the connection is not made.  In times of financial uncertainty, we have to be more careful with our money, don’t we?

One of the best and prudent ways to invest though, is in future generations.  In the US, we provide all of our children the best chance at life, with fewer worries about preventable, devastating disease.  Imagine what that kind of security could do for a family in Africa.  Healthier children in Africa would be able to stay in school.  Families would worry less about the all too common diseases of pneumonia and diarrhea, and their devastating costs.  Rather than accepting the fate that their children may fall ill, they would be thankful that new vaccines are being made available.  Throughout the years, as healthcare improves because of our investment, so would income and productivity. Our investment would return to us through a country’s improved stability, better governance, and more – and all directly relate to our own security. 

The introduction of a new vaccine is not something taken for granted in the developing world.  Up-to-date immunization cards of young children are among a family’s prize possessions.  Throughout Africa, pneumococcal vaccines, once deemed far from the reality of any African village are now being introduced and are offering hope.  Rotavirus vaccines, helping prevent one of the most deadly forms of diarrhea in young children, may soon also be a reality across Africa -  all for a relatively small fraction of the US budget.  How often do we have a chance to save so many lives with such an effective and minimal financial commitment?  Four million lives over a five-year period is a pretty good return on investment!

Let’s make wise investments

Next month, the GAVI Alliance will be holding their pledging conference to encourage donor countries like ours to contribute to providing the most basic and effective prevention.  Please tell President Obama and your local leaders that you care.  Sign the ONE petition, and tell your friends and family to do so. The more they hear from you, the more they know this is an investment we as Americans care about.  Do it for their future – and ours.

Photo credit: Adrian Brooks, Imagewis

By Rozalynn Goodwin. The rise of the Tea Party has come with increased concern over the federal deficit and strained state budgets, and cries for less government spending. The Medicaid program has a bright red bull’s eye target on its back, mainly because several erroneous stereotypes exist about its recipients who often don’t have the means to speak and fight for themselves.

The situation is no different in my state of South Carolina. Last week, one of our state senators referred to South Carolina’s Medicaid program as a “Mercedes health plan.”  Our Department of Health and Human Services responded by saying, “It’s a little bit of a stretch to call it a Mercedes.”

This morning, that same senator posted a guest editorial on FITSNews, “A Hand Up, Not a Hand-Out.”  In this piece, the independent pharmacy manager claims that Medicaid’s benefits are better than those of hundreds of insurance plans he works with.

“Hard working South Carolina taxpayers are forced to pay for premium coverage for others. These same hard working taxpayers could never afford these benefits themselves. Where’s the fairness in that? Welfare programs should be a “hand up” instead of a “handout.” Government assistance should be a temporary benefit instead of a lifestyle.”

The Senator says he and his colleagues in the Senate should focus on those unable to help themselves like the low-income elderly and mentally disabled. He then goes on to give two examples about welfare recipients who would rather get a check than work.

It’s disturbing that one of only six legislators in the entire South Carolina General Assembly with any type of health care experience would intermingle Medicaid and welfare as if the programs are the same. Some confuse the typical Medicaid recipient with the infamous Reagan-era “welfare queen.”  What an outrageous comparison.  Medicaid recipients don’t receive checks.  They receive access to health care services like primary care, prescription drugs, screenings, and hospitalizations.  High-paying-job-producing, tax-paying businesses get the checks and pump billions of dollars into the state economy both directly and indirectly. South Carolina hospitals, for example, employ more than 80,000 citizens, and contribute greatly to our state’s well-being and prosperity. Not to mention all the physician practices, nursing homes, health centers and other providers that do the same.

Let’s set the record straight on these Medicaid recipients seeking a hand-out in South Carolina:

• Two-thirds of Medicaid recipients live in working families, but their incomes are too low to afford insurance,
• Eligible families stay on Medicaid an average of only two years,
• A single parent making just more than $7,000 a year is too rich to qualify for Medicaid in South Carolina,
• And adults without children, regardless of their income, cannot qualify for Medicaid because they are categorically ineligible. (more…)

A recent article by Rachael Rettner originally published in My Health News Daily and on msnbc.com discussed how some researchers say a gene test can  measure the aging process including how long an individual will live, whole other experts say these are false claims. Read the article below to see what both sides are saying.

By Rachel Rettner. Researchers in Spain say they’re close to marketing a genetic test that could tell consumers how fast they are aging and, potentially, how long they will live. But experts say that such claims are false.

The Independent, a British newspaper, reported Monday that scientists are developing a blood test that would measure the length of an individual’s telomeres, or caps on the tips of chromosomes that protect the chromosomes from damage. Telomeres are thought to play a role in aging, and previous studies have found an association between telomere length and lifespan.

The test would tell an individual if their “biological age” — the age of their cells — matches their chronological age, the Independent reported. This information, in turn, might tell a person how many years of his or her life remain. The researchers hope to market their test to the general public later this year, sold by the company Life Length.

Estimating biological age

However, experts argue that the scientific understanding of telomeres is not at the point where such a test would be accurate. We know telomere length changes with age, said Carol Greider, a geneticist at John Hopkins School of Medicine in Baltimore who studies telomeres. But in the general population, the length of people’s telomeres varies widely. A 20-year-old and a 70-year-old might have telomeres that were the same length, Greider said.

“We cannot tell how old a person is by looking at their telomeres,” Greider told MyHealthNewsDaily. In addition, you can’t tell someone they have the cells of a 50-year-old, even though they’re 20, she said. “I would say that it is not possible to tell a persons ‘biological age’ from their telomere length,” Greider said. If a test says it will tell you how long you will live “clearly that’s not true,” she said. (more…)

The following is  a guest post by Margaret Polaneczky, MD, FACOG  a board certified obstetrician-gynecologist and Associate Professor of Clinical Obstetrics and Gynecology at Weill Medical College of Cornell University in New York City. It was originally posted on her blog The Blog That Ate Manhattan.

In an article filled with speculation, misinformation and broad sweeping generalizations, the Wall Street Journal does its damned best to make the birth control pill seem to be the worst thing to have happened to modern civilization, implying that by interfering with ovulation, the pill impairs our natural ability to choose a mate, causes women to choose less masculine partners and then stray from them, and makes us pick genetically similar rather than dissimilar mates.

Women on the pill no longer experience a greater desire for traditionally masculine men during ovulation…Researchers speculate that women with less-masculine partners may become less interested in their partner when they come off birth control, contributing to relationship dissatisfaction…That could prompt some women to stray, research suggests. Psychologist Steven Gangestad and his team at the University of New Mexico showed in a 2010 study that women with less-masculine partners reported an increased attraction for other men during their fertile phase.

“Less masculine” men. What the heck does that mean? Less hairy? Less into sports? Less violent? Not into Nascar or big trucks?

How about more likely to engage in conversation? More likely to care about their partner’s satisfaction in bed than their own? More likely to accept a woman having a career?

One could use the data to argue that the pill may be the best thing that ever happened to relationships as far as the female partner is concerned. (more…)

By Jane Sarasohn-Kahn. Americans are opting for Botox and cosmetic procedures more than colonoscopies and cancer tests, according to a story in Reuters.

This trend makes companies like Allergan, makers of Botox and the Lap-Band for gastric surgery, very happy indeed. Plastics and gastric bypass surgeries are back up to pre-recession levels as of 2Q11.

However, for companies and providers in other segments of the health care and surgery value-chain, prospects for bounceback in 2011 aren’t as promising. Various indices on consumers’ health care sentiment — such as the Thomson-Reuters Consumer Healthcare Sentiment Index and the EBRI Health Confidence Survey, show U.S. consumers’ perceptions of their ability to pay for needed health care falling.

Health Populi’s Hot Points:  The Reuters story shows the chasm in U.S. health consumers’ mindsets between their “health” and “health care.” In the past 50 years, health ‘care’ has been an entitlement largely covered by health insurance, at or close to 100% with minimal co-payments, coinsurance, and premium sharing. In the past decade, however, enrollee out-of-pocket costs have skyrocketed, with the average employee covered for a family of 4 now paying about 40% of health costs, according to the 2011 Milliman Medical Index, explained here in Health Populi.

Furthermore, Kaiser Family Foundation continues to track peoples’ self-rationing due to health costs. In their April 2011, tracking survey, 1 in 2 U.S. adults was seen to still cut pills in half, postpone recommended medical tests, delay dental care, and health “mis-behave” in other ways. Note that these are all self-rationing behaviors for health “care” issues.

So as we may skinny down our waistlines and de-wrinkle, our cancer diagnoses get delayed, costing us as patients precious time; our bank accounts, HSAs and health plan sponsors higher costs; and, diminishing public health. This scenario needs a good nudge toward value-based health plan design and positive consumer health behavior. Furthermore, health citizens need to connect-the-dots between prevention and outcomes, as well as whole health — that today’s health micro-choices bolster outcomes and quality of life for the long-term.

Originially posted on Health Populi on May 16th.

By Cynthia Flynn. One day several thousand years ago, a Columbia mammoth (larger than his woolly mammoth cousin) died.  His bones have lain in a rural area south of Kennewick, WA.  I recently met a paleontologist at his dig, where this mammoth was being unearthed.  Eastern Washington, he told me, has probably 300 sites with at least some mammoth bones, so this dig is hardly unique in that regard.  However, there are important differences between his dig and what is ordinarily done.  He explained that usually, the goal of a paleontologist’s dig is to get the bones out and back to a museum for preparation and analysis as quickly as possible.  It would not be unusual for a paleontologist to do test bores, identify where the limits of the bones were, and dynamite the earth beyond those limits to loosen the earth from the bones.  A site such as the one he was digging might take two months to excavate, however if the bones were thought to be fragile, perhaps it would take two years (seasons, actually, as digging does not occur in the winter in this part of the country). 

Interestingly, he said he hoped to spend 5-10 years at this site.  He wanted to excavate the bones using archeological techniques, i.e., careful delineation and recording of the exact locations of extracted items, carefully taking down the hillside in 2 meter by 2 meter by 10 centimeter layers using levels and small brushes and tools that looked like they belonged to a dentist, washing all the soil that is removed from the hillside to expose anything that remained of living things, and reviewing all the residue under a microscope back at the Burke Museum in Seattle where he works.

Why does he want to conduct the dig in this way?  Ordinarily, people just want to get the bones out.  So if he comes to a dig after most paleontologists have been there, everything (except the bones) is essentially destroyed.  In one case, he was able to get data from a 5% core sample before the bones were extracted, which gave him unique information that he was interested in, but this sample had all the limitations of any small sample as far as understanding the full universe of data from which it was drawn.  Even with this small sample, though, he was able to create a unique data base that received scholarly notice.

So why does he care?  He replied that most people actually don’t care, which is why this project is self-funded, uses volunteer staff, and occurs on the week-end, when everyone is not at their “day job.”  But exactly what does he want to find out?  The answer is that he wants the full story, or as much of the story as is still available after thousands of years, about what happened around the day the mammoth died.  Did the mammoth die here?  Or were the bones washed here by a flood?  Did they end up here due to a mud slide?  What can we learn about what else was going on at that time by examining the environment around the bones?  Were there rodents (which kinds?), insects, seeds (of what?), nests?  How much of the story of this mammoth can we reconstruct if we do a careful analysis of the site?  In other words, how fully can we describe this particular mammoth’s story?  And what happened before this animal died? What happened later?  The point is that context matters, the story matters if we really want to understand “the bones.” (more…)

National Women’s Health Week is a weeklong health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health. It brings together communities, businesses, government, health organizations, and other groups in an effort to promote women’s health. The theme for 2011 is “It’s Your Time.” National Women’s Health Week empowers women to make their health a top priority. It also encourages them to take steps to improve their physical and mental health and lower their risks of certain diseases. Those steps include:

• Getting at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both, each week
• Eating a nutritious diet
• Visiting a health care professional to receive regular checkups and preventive screenings
• Avoiding risky behaviors, such as smoking and not wearing a seatbelt
• Paying attention to mental health, including getting enough sleep and managing stress

Learn more about National Women’s Health Week.

By Archelle Georgiou. There have been several blogs and articles written on the grammatical appropriateness of “health care” versus “healthcare.”  In Michael Millenson’s post on The Health Care Blog, he explains that the Associated Press (AP), which dictates journalistic style standards, says the correct usage is “health care.” Two words. Most major journals, newspapers, and media sites follow this convention, but it may not be the end of the debate.

There is an equally accepted convention that says that “health care” is correct when there is reference to a provider’s action, and “healthcare” is used when it is an adjective to modify another noun or verb—healthcare system or healthcare marketing—for example. And, there are many sites that shift, very consistently, between these two approaches depending on the sentence structure.  

I can live with 2 different literary conventions … but here is what is keeping me up at night and: literary styles change. 

“Airline” used to be “air line” and “website” was formerly “web site.” Similarly, there is pervasive evidence that the “health care” is turning into “healthcare.” In my own cursory review of sites that I respect–WebMD.com, Kaiser Family Foundation, the Institute of Medicine, I found that “health care” and “healthcare” are used interchangeably without grammatical rhyme or reason.

So, why do I care? And, why should you care that the adjective, “healthcare,” is well on its way to becoming a noun or a verb? In fashion, style changes drive revenue. On Twitter, eliminating the space creates capacity for one more character. However, in health care, eliminating the space and turning two words into one, will have a negative impact on people, their well-being, and thereby, worsen an already deteriorating system.

Take a moment to do an experiment:

1)    Write the following sentence on a piece of paper: Healthcare is important.

2)    Show the paper to a few different people, and ask them to explain what the sentence is referring to when it says “healthcare.” Listen for the meaning they ascribe to the word “healthcare.” What is the first thing they say? Most likely, they refer to insurance, access, costs, and/or health reform.  Do any even refer to the quality of care that they receive from doctors or other care providers? Do they refer to the importance of their own lifestyle behaviors? Probably not. In my experiment en route from Minneapolis to San Diego yesterday, with an n=5, only XX said anything about care, and only as an after thought.  (more…)

The completely updated 200-page Alliance sourcebook, “Covering Health Issues, 6th Edition,” is now available.

Written with reporters in mind, “Covering Health Issues” is useful for anyone looking for concise information on health policy issues, and experts from across the political spectrum. Chapters contain fast facts, background, tips for reporters, story ideas and experts with contact information. The book also includes an extensive glossary, ideas and examples for TV and radio reporters, and links to polls on health issues. Supported by a grant from the Robert Wood Johnson Foundation.

To see a video demonstration of the book by Julie Rovner of NPR, click here. To see individual chapters, click on any of the chapter titles below. To download the entire sourcebook as a PDF, click here.

For all chapters, links are available to local news stories on the chapter topic. For many chapters, there is also a short video featuring one of the nation’s top health policy experts.

Table on contents:

• Introduction and Acknowledgments
• Health Reform
• Cost of Health Care
• Quality of Care
• Employer-Sponsored Health Coverage
• Individual Health Coverage
• Children’s Health Coverage
• Medicare
• Medicaid
• Long-Term Care
• Disparities
• Mental Health and Substance Abuse
• Public Health
• Polls on Health Care Issues
• Covering Health Issues for TV and Radio
• Acronyms and Glossary
• Experts
• Websites

The Alliance for Health Reform is a nonpartisan, not-for-profit health policy education group. We are committed to helping journalists, elected officials and other shapers of public opinion understand the roots of the nation’s health care problems and the trade-offs posed by various proposals for change. Our aim is quality, affordable health coverage for all in the U.S., although we do not lobby or take positions on legislation. Sen. Jay Rockefeller (D-W.Va.) is our founder and honorary chairman; Robert Graham, MD, of the University of Cincinnati is our board chairman.

The following is a guest post by Jenni Sunde. Jenni is a freelance fashion writer and pop culture junkie. She specializes in all things lifestyle-related. From home and design to health and beauty. With her love of art and all things beautiful, she delights in sharing her sense of style from her life to your computer monitor. Her title pegs her as an editor at a website that specializes in providing people with car insurance quotes, but her passion leads her into writing with a little more substance and a lot more heart.

By Jenni Sunde. The benefits of a sound mind and body can be traced all the way back to ancient Greco-Roman cultures.  Despite how long the concepts behind mind and body connection have been around, they are frequently overlooked in our modern society.  The connection between mind and body is particularly impactful for adolescents; studies have shown that happier youths are indeed, healthier youths.

Emily Shaffer Hudkins and her team of researchers at the University of South Florida conducted a study that focused on the impact that positive emotions, moods and overall satisfaction with life has on the health of teens.  Her research shows that these positive feelings, also known as subjective well-being are more significant than depression and anxiety when it comes to physical health.  Psychopathology has long been where the emphasis is placed when it comes to determining how the mind and body are connected. 

Hudkins conducted an experiment with 401 students, grades 6-8 from a suburban southeastern middle school in the US.  She monitored both their subjective well-being and psychopathological tendencies.  The study asked questions about the teens’ satisfaction with life; whether they were strong, proud and excited, and whether they felt lonely, guilty, or sad.  What Hudkins founds is that good mental health most often is linked to good physical health.  Mental health indicators explain roughly 30 percent of the difference in physical health ratings.  The findings show that subjective well-being has a significant, unique and primary affect on predicting important physical health outcomes in youth.  In other words, subjective well-being is more strongly associated with physical functioning than psychopathology.

What Emily proposes is that we change our wellness models to ones that are more holistic, so as to incorporate the entire spectrum.  With current standards, the subjective well-being is often overlooked in terms of its impact on physical health when it actually is more prominent than poor mental health in terms of how much it can affect the body.