TED Conversations

Closing Statement from Michael J. Barber, VP, GE Healthymagination

Well, TED community, now that our conversation has come to a close, I’d like to thank you all for sharing your thought-provoking questions and insightful ideas on patient behavior. I also want to thank Dr. Nancy Snyderman for participating and for bringing her valuable medical perspective to our discussion.

Over the course of the conversation, some key takeaways for me included:

+ It takes time to drive real change in community healthcare systems but it is worth the effort to increase access, decrease costs and improve the quality of healthcare.

+ Being smart and honest with our healthcare providers goes a long way no matter which country we live in.

+ We can save 100,000 lives a year by preventing hospital errors.

+ Learning about health early in life and developing good habits can have a big impact on our healthcare system in the future.

+ As patients become better armed with information through technology, we will see the patient/doctor relationship evolve into something more meaningful and efficient.

+ If good health is a priority in the workspace, these habits will translate into the home.

This has been a great first experience with TED Conversations for me and I hope to meet you all in the digital healthcare space again soon.

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      Jul 22 2011: Erika - You have hit on two challenging health industry issues: wellness and the doctor/patient relationship. Regarding the first one, I like what I see in some spaces online today in terms of helping people make healthy choices. Two companies that we’ve collaborated with over the past few years are MedHelp and HealthLine. Both do an excellent job creating tools that provide good health information as well as steps you should take to better manage your health. MedHelp has created apps that encourage good choices around sleep, nutrition and fitness and HealthLine has created BodyMaps -- an interactive tool that can guide people through what is going on inside the body during different conditions. The concept of gaming in the health space has a lot of potential. GE is actually hosting a summit on health gaming in NYC next week, which I look forward to joining.

      On the topic of the doctor/patient relationship, we recently sponsored a related study, which launched at the Vancouver Olympics. Some of the results were thought-provoking. For example, 77% of healthcare professionals said that one fourth or more of their patients have lied to them about their health. More people knew how many vacation days they had left (47%) than how many calories they’d consumed yesterday (43%). At the link here, you can click through a data visualization that outlines all of the findings: http://www.healthymagination.com/projects/better-health-study/. We collaborated with WebMD on this topic to develop an interactive tool that guides the patient though what questions/dialogue they should be having with their physician.
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        Jul 23 2011: Michael, how about incorporating in our education sysems healthy lifestyles and the clear consequences of abuse to our body systems.

        Some people are more aware of their vacation or sick leave days is probably a sign of work stress that sometimes encroaches on the daily pressures of family life. Are there studies too about shorter or more fleixble work days resulting in better productivity and health?

        My general suggestion also is to raise awareness at all levels and at any stage of our lives the power of our minds to understand the dynamics of our healthy and self-healing bodies, and the caring of our hearts to be more responsible and contributing also to the healthy welfare of the people close to us.
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          Jul 25 2011: I couldn't agree with you more about the importance of teaching healthy lifestyles in our education system. For five years now, GE Healthcare has supported Dr. Olajide Williams, MD, MS, a neurologist at Harlem Hospital. Better known as the "Hip Hop Doc," he is the founder of the Hip-Hop Public Health Education Center, which uses hip-hop to teach school children (and their families) about health. Hip Hop H.E.A.L.S (Healthy Eating and Living in Schools) is Dr. William's program that educates children about health at their schools. The Hip Hop H.E.A.L.S program works to prevent disease in school-aged children which are mainly caused by unhealthy eating and lack of exercise. With the help of all-stars like Doug E. Fresh and Chuck D., Hip Hop H.E.A.L.S was created to empower kids about these issues through professionally produced hip-hop music, hip-hop video games, cartoons, choreographed dance moves, and comic books that all focus on nutrition and exercise. The goal is to help lower rates of obesity in Harlem and help prevent the other diseases that are associated with unhealthy lifestyle choices such as diabetes and high blood pressure (hypertension). The program has been successful in Harlem and now reaches 12,000 New York City school kids a year. Last month we joined Dr. Williams and his team in Harlem to celebrate the 3rd Annual Hip Hop Public Health Summit and the release of “Hip Hop Health Vol. 1,” a compilation of educational rap songs for kids which cover a wide-range of health issues, including “Stroke Ain’t No Joke,” “Exercise and Be Calorie Wise” and “Go Slow Whoa,” a song that groups foods into easy-to-follow stoplight commands. You can check out some highlights from the summit here: http://www.gereports.com/doug-e-fresh-chuck-d-and-the-hip-hop-doc-celebrate-health-in-harlem/. Learning about health early in life and developing good habits will have a big impact on our healthcare system in the long run.
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    Jul 22 2011: My experience as a doctor tells me generally people avoid going to doctors,as they think that nothing is seriously wrong with them.People tend to think tfinancial aspechat all bad things happen to others, but not to them.In India, it is common to try home remedies,alternative systems of medicine before they consult an allopathic doctor
    Secondly ,many are of the impression that medical practitioners ask for too many unwanted investigations.To add to all these is the inconvenience of going to the hospitals, waiting for the doctors, visiting various departments for investigations and the most important expenditure they are likely to incur deter people from going to hospitals.
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      Jul 22 2011: It is interesting that cultural differences play roles in how we regard our physician/healers and how we access the health care systems. I know it can be dangerous to compare countries and the structure of medical systems, so let me address this as a surgeon who has traveled the world but only treated people in the United States.

      Most of us prepare more time thinking about what we want to get at the grocery store or market than we do before seeing the doctor. But whether sick or healthy, preparing for that visit can save time and allow us to get more out of the visit. Sharing information can be frightening. But I think it is just as scary when doctors don't take the time to ask the basics....how are you? how is work? How is your marriage and the children? Are you under stress or sad? The social aspects of our lives can influence disease and illness.

      The bottom line for all of us, anywhere in the world, is to do the things in life that can keep us healthy, share the burden of staying healthy with our health care provider, and use the hospital as a last resort. Being smart and honest go a long way no matter which country we live in.
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        Jul 22 2011: I was so happy to read your response. I am really lucky, and have an incredible GP who encourages my involvment, and who understands that we have a relationship, that he is the advisor, but that I am the decision maker. Sadly, far too few doctors encourage, or even tolerate, an involved patient. Doctors should be actively training patients to be better patients, and patients should be encouraging doctors and health care professionals to work with them, not for them or on them. Thanks for giving us a broader view of a balanced visit. (Needless to say, the above is impossible when financial concerns of privatized medicine are involved.)
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        Jul 23 2011: Dear Dr.Nanacy,
        You touched upon the most important aspect of doctor-patient relationship i.e.taking time to ask basics.,2 decades ago when there were not many specialities and specialists,a family doctor used to play a significant role in people's lives.He or she was the doctor,counsellor,friend,philosopher and guide.People had immense faith in their family doctors.Now with the advent of multi speciality hospitals ,medical technological advances and commercialisation and insurance,people think twice before going to hospitals.Many feel that they are not people friendly.Here in Bangalore we have a NGO known as"Helping Hand" whose volunteers visit the hospitals and help the patients and their families.Probably,we need more volunteers to do this kind of work.I strongly feel that medical students should be trined in communication and counselling skills.
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    Jul 21 2011: I don't believe the solution is as simple as figuring out how to make people make tough decisions. This is a complex issue/problem. Technology, simple solutions (like checklists) and mandates all have been implemented in an attempt to improve our health care system. Billions of dollars have been spent on research for and implementation of these various initiatives. Complexity science and systems science explains why we have not seen sustainable improvement- we have not changed our health care system structures. As long as we continue to have individual physicians acting independently and hospitals designed in hierarchies with vertical departments, we will not see improved health care no matter how much technology, information and money we allocate to these systems. We need to re-allocate resources to the horizontal processes that are the important processes to be defined, measured and improved- the cycle of care for each patient problem and disease from the patient's perspective. The solution is relatively simple- develop care teams (with physicians acting as a part of a team) and communities around definable patient problems and use continuous clinical quality improvement principles to create value. The implementation is challenging because of the strong attractors in place for the people in control of the resources in our current health care system structures to maintain the status quo, especially at our traditional academic medical centers. I would change your question to: How do we change our health care system structures to enable sustainable improvement for the health of our society?- each problem will require a variety of emergent solutions driven by engaged, accountable communities.
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      Jul 21 2011: Hi Bruce – Really interesting thoughts here. We’re working on one project that might interest you – an experiment along the lines of developing a community-wide consortium of employers, payers, providers and patients who are focused on reducing costs, raising quality and increasing access to healthcare. In Cincinnati, where GE has a major presence, more than 12 percent of its population lacks health insurance, the mortality rate is higher than average and annual health spending increases have been averaging eight percent. In early 2010, GE coordinated with community leaders and other local corporations to catalyze citywide approaches to reducing costs and improving quality of and access to care. The community’s goal is to drive $1 billion of cost out of the system – while improving outcomes – by 2014. It’s been a marathon – not a sprint. Even though we like to see progress quarter-by-quarter at GE, we realize that it takes time to drive real change. In Cincinnati, it took creating an executive stakeholder board, agreeing on a set of metrics, developing incentive plans for Patient Centered Medical Homes (PCMH), creating patient engagement portals and there is more to come, but the needle is moving. The question we’re asking ourselves now is how to repeat this model in other communities.
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        Jul 21 2011: Thanks Michael- that sounds like a marathon. Congratulations on the effort so far. It is very challenging to get all of those stakeholders to work together. We are working on more of a bottom-up approach, starting a new academic medical center with just five divisions, to start with- hernia disease, obesity, breast disease, GI disease and trauma. We are building teams around these patient groups and defining dynamic care processes and outcomes measures. We have a group of engineers on our teams to apply clinical quality improvement processes to learn and improve value within these processes. We are working with industry partners to learn where their products have value (and where the don't have value or cause complications) within these care processes. After a year of planning, we are starting the implementation now. Thanks again for the interest.
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        Jul 22 2011: This project sounds fantastic - as long as people from ALL INCOME LEVELS are included WITH EQUAL SAY, and as long as there is equal/fair representation from genders, cultural groups, and age groups. Please post where to find the findings once they are published!
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    Jul 20 2011: what about partnering with insurance compaines and giving people breaks on they're insurance if they get regular check ups? offer free screenings, we know that specialist doctors make enough money anywho.
  • Jul 28 2011: I would put the most important issue at ease/comfort of access. Access to the Dr.'s office, access to information from the Dr., financial access to the necessary treatments and last but not least realistic access to the ability to change your life as might be needed after you get your results.

    The reality is people, for the most part, won't do things that aren't somewhat convienient.

    It boils down to is people don't want to know. It's not worth the aggravation of finding out. Even if everything goes wonderfully in a Dr. visit health-wise the experience sucks. Its dehumanizing and usually makes you feel guilty for something you aren't doing that you should for your health.

    If there are problems discovered in a visit people can't perceive how they can change their lifestyle to what they THINK they might have to without losing the things they like in their current lifestyle.

    Basically your job is to market an experience that is unpleasant (at best) well enough that people will go through it often enough to get the bad news sooner.

    My primary suggestion is to make your organization show their clients/patients respect. Make appointments mean something. Charge a fee for no show (not covered by insurance of course) if necessary but respect your patient's time and them. Make the action of visiting as painless as possible so that people will be willing to at least take that first step. Give them reasonable access to their Dr.

    At the other end of the contact give them access to support in making changes that they can't see how to make. Changing your lifestyle is HUGE and looks expensive to the patient. The online social networks are probably one of the best tools for that but don't just hand them a network name or website and let it go. Make it a part of the Dr.'s clinic or practice to be involved at this end as well.
  • Jul 27 2011: I think about this a lot - why people find it so difficult to take responsibility for their health - it polarizes my thinking from one extreme to the other and back on a regular basis. On the one hand, I believe in the freedom of the individual to shape their own lives; on the other hand I believe we have a responsibility towards each other and to society as a whole.

    Case in point (and bearing in mind I live in a country with a single-payor socialized health system (and very good it is too):
    Last week, my father had a successful heart bypass operation after a series of heart attacks (he thought indigestion) caused by severe coronary artery disease. He never smoked. He is far fitter than the average 68 year-old, cycling upwards of 100 miles/week. He eats a largely fish/vegetarian diet out of preference, has been very active all his life, and drinks in moderation, and he has been very proactive over the last 15 years in managing his health. Yet genetics through him a curve ball and the UK's NHS has just spent ca. USD 20,000 re-doing the plumbing around his heart.

    Outside the hospital when I visited, stood an army of smokers, many of them far from their ideal BMI, many of them on drips, some in wheelchairs...and I thought "Really? Should the NHS be paying for this? Their irresponsibility is causing an unnecessary drain on health resources, " I ranted at my brother (I was emotional - seeing your dad intubated in the ICU is never nice). At which point he (who is actually rather clever, and also works in health), pointed out: "Where do you draw the line? Do you refuse to treat drivers who crash their cars driving over the speed limit?" causing a crash of moral reasoning. I don't know.

    So how does the payor (state or insurance company) encourage better health behaviours? I don't think there is one answer - I think there are many, and they are likely different for everyone - what would make you look after your health the way you should?
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      Jul 28 2011: Conor – It’s nice to see a fellow GE employee participating in this conversation on patient behavior. I hope your father is doing well. We often have the “carrot” and “stick” discussion within GE, as you know. Do you incentivize people by paying them a cash bonus for going to the gym? Or do you charge them $10 for their hamburger in the work cafeteria and $3 for their salad?

      You know as a GE employee that through our internal health initiative – HealthAhead – we’ve focused on helping employees improve the way they eat, work and live through both carrot and stick approaches. For example, by the end of 2010, 120 out of 295 GE-owned-and-operated campuses were tobacco-free. What I’ve taken away from our HealthAhead initiative is that employers can help set the tone for their employees. If good health is a priority in the workspace, these habits will translate into the home. We hope this will have a lasting impact on the individual employees and their families.
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    Jul 26 2011: 1. [...] "how can we explain why we remember to do our taxes but put off getting screened for serious conditions -- especially when we know that early detection offers the best outcomes?"

    Abstraction. As Terence McKenna once said, "Abstraction is the knife poised at our hearts."


    2. "And, how can we design systems and tools that reverse this behavior?"

    Meet peoples needs and develop their potentials.
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    Jul 26 2011: While we wrestle with how best to spend our health care dollars and the belief that screening for certain diseases can save lives, I would like to know what you think.

    Cancer of the colon runs in my family so I started colonoscopies at the age of 40. But breast cancer I have no risks for and probably could have put off screening until I was 50.

    What are your beliefs about screening? What do you do and where do you turn for advice?
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    Jul 26 2011: Good afternoon, TED community. I wanted to share with you all something exciting happening with GE in the healthcare space. Today in New York City, we are hosting our first-ever Health Gaming Summit. It is a deep dive into how social gaming, personal tech and mobile devices can catalyze innovative behavior change and foster greater engagement for everyone. Our summit brings together thought leaders in personalized healthcare, sensor and mobile technology -- the leading minds among policymakers, entrepreneurs and technology developers. The event features a talent roster of pioneers in the space including Ben Sawyer, the co-founder of Digitalmill, John de Souza, CEO and President of MedHelp International, Inc. and medhelp.org and Steven Wardell, Vice President of Marketing at Mednetworks, Inc.

    Gaming is re-shaping the healthcare space as we know it – from academia to the way we consume personal health data. We are beginning to see a trend in marrying data with everyday products, allowing us to gather information seamlessly, without disrupting our lifestyle. With these advances in technology, we can actually make patients smarter. This is where it gets exciting. As patients become better armed with information through technology, we will see the patient/doctor relationship evolve into something more meaningful and efficient. Our goal for today’s summit is to explore this new space, to discover new ways to effect change through personal technology and to play our part within this healthcare revolution.
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      Jul 27 2011: Hi Michael, for further insights into gaming and its potential for use in your field I recommend the following book that I am reading and loving.

      Supercooperators : altruism, evolution, and why we need each other to succeed

      Martin A. Nowak, with Roger Highfield.

      Nowak is a mathematician working in the field of evolutionary biology and he studies game theory especially Prisoner's Dilema. He demondrates many applications.
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        Jul 28 2011: Thank you so much for the book suggestion, Debra. I'll have to pick this up and see what I can learn from it. I welcome any other book suggestions you might have.
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    Jul 23 2011: How about improving also our healthcare systems. According to World Health Organization - Medical Errors and Health Care Related Infections (are) Causing Majority Deaths

    http://www.frenchtribune.com/teneur/116302-medical-errors-and-health-care-related-infections-causing-majority-deaths-who
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      Jul 25 2011: It is a passion of mine to call attention to medical errors and get back to the basics in medicine which can be as simple as washing one's hands. I am horrified to see doctors in the United States underestimate the importance of preventing germ contamination from one patient to another. The idea that we can save 100,000 lives a year by preventing hospital mistakes is one reason why I was trilled to join the board of the Institute for Healthcare Improvement in Cambridge, MA. The Institute follows the passion of Dr. Don Berwick and the concept that we can improve the health care of people worldwide - sometimes with simple changes and sometimes by rebuilding health networks and systems.
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        Jul 27 2011: Hurrah for Nancy on this one. I actually started a thread to draw attention to this issue here on TED.
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    Jul 22 2011: I think a lot of why people do not always get proper medical advice and treatment is because of the lack of knowledge for the common every day person. Only doctors and other specialist really understand the risks and causes of most serious diseases and whatnot, so getting screened for things like TB do not make it very high on an individual's "To-Do" list that day. Most people tend to take the "it won't happen to me" philosophy and use it to make up excuses to not get proper medical care. Many cases of serious disease and disorders do not get publicized very often expect for special cases, so it is only these special cases that make a scene to the rest of society and individuals subconsciously compare themselves with these people and realize they are very different people, meaning there is no connection between themselves and that disease/disorder. This is the wrong logic to use but it is used nonetheless. If people become more informed on probabilities of obtaining certain diseases and illnesses then I think it would draw more attention to screenings and precautionary measures.
  • Jul 21 2011: I think (for people with health concerns) a big part of can be fear that something is wrong. Or fear (if you've already got health problems) that the next step is going to be too unpleasant...

    I also think (for people without health concerns) that it isn't really an issue to them, so they don't bother.
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    Jul 21 2011: I think that there are simple human based solutions that take the realities into consideration.
    One, we need to simply have good scheduling and reminders. People are busy and people forget things that can be put off. If I worked for GE I would work to computerize doctors' offices and in exchange for good free software the doctors' patients would be put on an automatic alert and scheduling system that would go to their computer inboxes for yearly testing. It would be a positive step to confirm or reject the testing date and most people would accept and attend.

    Less routine testing, like MRIs would be on an alert system too as soon as the doctor ordered the test, the patient would be coordinated with the provider with a date and time.

    We would also need to reduce fear. Understanding just how fearful some of these issues can be especially when faced with a cold and impersonal system, is key. Why not supply information directly to the patient by the same computer programme to help them understand EXACTLY what is involved in the test. How often the test gives people a new lease on life by proving that they are fine and how the system will enable them to get the best help if there is something to work on.
    In the face of the medical system most people feel powerless. Empowering through information is one great step forward.
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    Jul 21 2011: Because it often leads to such a heart breaking issues.
    The real question is how is government and medical community do not see that health is one need no human can bargain with ?
    Putting price on medical products are putting price on human lives.

    I'm sorry...
    I know this doesn't help.
  • Jul 20 2011: This is a difficult question.

    We do our taxes because we know the taxman will come looking if we don't and the repurcussions are worse than just doing your taxes.

    Whereas with your health, if you're getting screened for something, you think i'll probably not have it. With the Doctors you weigh up the probability of having some condition over the likelihood that you don't. Even if the likelihood is high that you will develop something due to being overweight, we still to continue to put off losing weight to reduce the risk mainly i think because you like eating and your exercise rate at the moment. There is a small chance that no health problems will be created and if they do, you'll deal with them then. There's the it won't be me chance as well as losing weight is too much like hard work.

    I've had personal experience of knowing there was something but not going to the Doctors well its slightly more complicated. I injured my knee a year ago in the semi's of my club championships(doubles), played on and we won. i couldn't walk the morning after so went to A&E, diagnosed it as ligament and would heal fairly quickly so I decided to play in the final 3 days later, knowing if it was ligament, it wouldn't make it worse. A year later still having problems with it, private clinic said maybe cartilage, NHS keep saying ligament. At easter when it was particularly troubling, i resisted going to the GP again because I knew what was going to be said - "its ligament, go away".

    What would have helped me - better diagnostics through better technology but at the end of the day - I'm not sure anything would have stopped me from playing that final. I wanted to play. Rational thoughts about health didn't come into it.
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      Jul 21 2011: Hi Nicola. I found the comments about your knee injury interesting. You are right that thinking about our health doesn't always enter our minds before we try to go for the gold medal – at least for us non-professional athletes. Diagnostics are an important part of medical treatment. If tests are inconclusive, it’s frustrating for a patient to have to return to the doctor or visit more than one physician. Multiple appointments can also drive up costs. Although breakthroughs in technology are helping doctors do more for patients every day, one simple thing that patients can do when a diagnosis is conclusive is to follow their doctors recommendations – as simple as that sounds. According to government estimates, $100 billion of cost is incurred every year in the US due to preventable hospitalization, emergency room, and repeat physician visits. In that case, the specific driver is not taking medications properly. It wasn’t so cut and dry in your case, though. The human body sometimes has a clock for healing that is independent of anything we might wish. I think we have all been there. Common sense, combined with an astute use of the web and finding a health care partner who will listen to you is the best medicine (and perhaps not trying to score every goal). Building on the web/data theme, I think it’s fascinating today to see how much information is available to consumers about their health. Sites like MedHelp, Healthline and WebMD make medical information more accessible to the masses than ever before. Being so well armed helps patients – whether rural or urban, rich or poor – improve their awareness about the most cutting edge procedures and then ask their doctors more informed questions during appointments. You don’t have to live near a top academic institution anymore to gather information about the best treatment paths for whatever ails you. This is promising.
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    Jul 20 2011: Great questions, I like to imagine the the human brain works somewhat off a scale of importance. Everyone knows that if you dont do your taxes you'll have an IRS agent banging on your door and possibly take everything you own but if your doctor wants you to come in and get a prostate exam and you dont, its not like he's going to go and pound on your door to drag you into the doctors office.

    it's a sad thought to think that people are more scared of the IRS than they are of dying. if the persons condition isn't physyicaly or mentally effecting them they are more prone to hold it off untill they are sick, weather or not they could have prevented it from occuring in the first place. out of sight out of mind.

    On a near by reservation there are a large number of deaths caused by strokes and heartattacks and beacause of that they put up billboard signs listing the causes, symptons, and preventatives of strokes and heartattacks. that apparently has not only made people more aware of whats going on but also help drive the number of deaths down considerably.

    To help make people aware and get screenings done I think that it more depends on the demographic your in, billboards may work for us in between our rural communities but TV commercials may be better in other places.