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Health watch 2019: Experts offer ideas about what to look for in the coming year

Anyone wondering about the impact of health care in the Northland need only look toward Duluth's medical district, where Essentia Health and St. Luke's plan to spend more than $1 billion in construction in coming years. The beginning of this unpr...

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Anyone wondering about the impact of health care in the Northland need only look toward Duluth's medical district, where Essentia Health and St. Luke's plan to spend more than $1 billion in construction in coming years.

The beginning of this unprecedented medical building spree will be something everyone watches closely in 2019.

But what else can we look for in the world of health? The News Tribune talked to health experts from a variety of perspectives to get an idea. What follows is a synopsis of some of what we heard.

Addressing mental health

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"Mental health is emerging as a huge, huge issue," said Terry Hill, senior adviser at the Duluth-based National Rural Health Resource Center. "We're getting more and more depressed people, less mental health services, and it's costing us an extraordinary amount."

In the Duluth area, there were 11.8 suicide deaths per 100,000 people in 2016, noted Megan Halena, program director at Generations Health Care Initiatives in Duluth. That was up from 11.2 in 2011 and continued a disturbing long-term upward trend, she said.

The term "mental health" actually might be heard less. Linda Curran, adult mental health supervisor for St. Louis County, said the county is following the state's lead in merging mental health and substance abuse disorder under the umbrella of behavioral health.

State data show that 64 percent of those using illicit drugs also have some sort of mental illness, Curran said. Treating both at the same time has been found to be more effective than treating them separately, she added.

Convenience counts

"I think we're going to see a lot of virtual medicine," Hill said.

A study released late last year by the Minnesota Department of Health and the University of Minnesota School of Public Health found that telemedicine - allowing medical consultation to take place from a remote site - is a small but fast-growing segment of health care in the state.

Virtual medicine takes that a step further, Hill said, to Amazon.com-style medicine. And it's trending from the West to the rest of the country.

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For example, Hill said, his daughter in the Phoenix area can have a video conference with a doctor or nurse practitioner in the middle of the night if one of her children becomes ill.

"We're going to see these alternatives," Hill said, "and I think hospitals ... and clinics, too, are going to have to really cater to kind of an 'Amazon' customer base."

The rural challenge

Providing comprehensive medical care to rural America will be a continuing challenge, said Dr. Ray Christensen, associate dean for rural health at the Duluth campus of the University of Minnesota Medical School.

Christensen mentioned obstetrics, general surgery and psychiatry as specific concerns. His comments suggest that both mental health and telehealth are part of the rural health puzzle.

"The ability for a person to live, say, outside Baudette and be able to telehealth with a psychiatrist and work through medications some distance away without travel is very important," he said.

Part of the mission of the Duluth campus is to train future doctors to serve in rural areas, but Christensen said there's a need for expansion in that area.

For example, with a rural training track in family medicines, medical residents could spend the first of their three years at Essentia Health or St. Luke's in Duluth but move to a more rural setting for their second and third years, he said.

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Medical science advances

Two advances in medical science are starting to change the way diseases are diagnosed and treated, said Dr. Douglas Wood, the medical director at the Mayo Clinic's Center for Innovation.

Machine-based learning, aka artificial intelligence, gives physicians a greater ability to analyze information, such as what patients say and what scans show, Wood wrote in an email. The developing field of pharmacogenomics "allows us to understand how the body metabolizes drugs." In part, that means drugs can be prescribed more precisely based on the individual's genetic makeup.

The latest generation of smartphones fits in here, wrote Wood, who is president of the Minnesota Medical Association.

The ability to use a smartphone for an electrocardiogram "is already changing the way we can help people diagnose heart rhythm abnormalities since they can capture an electrocardiogram during symptoms without having to worry about racing to the ER or the doctor's office," he wrote.

But wait, there's more

• The Bridging Health Duluth group, which includes Generations, plans to focus this year on anti-tobacco efforts and food access, among other things, Halena said. When vaping is included, student tobacco use is up 25 percent, she said. As for food access, she cited a survey finding that 41 percent of residents in Duluth's Hillside neighborhoods report worrying about running out of food. "That is a really unacceptable figure," Halena said.

• In the area of drug abuse, fentanyl likely will continue to be a major and unwelcome force, said Carol Falkowski, director of the Twin Cities-based Drug Abuse Dialogues. "This potent painkiller that is being mixed with street drugs like heroin, but also with methamphetamines and cocaine, certainly results in overdose deaths," she said. "Many times the users and the sellers of it have no idea that this substance is present."

• Look for more consolidation in the health care industry, Christensen suggested. The Grand Itasca Clinic and Hospital affiliation with Fairview Health Services in 2017 is a recent example. "I think there might still be some more." On the macro scale, Hill pointed to CVS's acquisition last year of the insurer Aetna. CVS wants to cut back on retail sales and offer physician-run clinics at its sites, Hill said. That would mean more competition for hospital-based clinics.

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