And what about a family history of substance abuse?
If we know someone is at risk for substance abuse, we do counsel them on it. They need to be aware they have the potential to become an alcoholic or to abuse drugs – so either as teens, they choose not to start, or they really keep an eye on it because they have that predisposition.
How do you suggest gathering health information on deceased relatives?
Ask other family members who knew them – and asking probing questions, like what medicines did you see in their medicine cabinet? Were you caring for them? Who did they live with? And you can certainly request the death certificate; usually, it will give some indication of what the person died of.
What do you say to people who think they have no reason to collect this information, because "no diseases" run in the family?
Well, oftentimes we don't know what we don't know. Most of us have family members who died at some point. And even knowing what they died of and how old they were is a predictor. Some people have longevity genes in their family, and that really predicts they're going to live a long time. If I notice someone's parents and grandparents lived to their 90s, and that person is in his 50s, I'm saying: "You're going to live another 40 years, so we have a lot of time to be keeping you healthy."
Can family health history help lower medical costs?
Yes. A huge chunk of our health care spending is taken up by chronic disease management. So if we can focus on preventive care, our hope is that we can start to shift that cost curve over time. We want healthier people, which translates to healthier families and healthier communities. And family health history is part of that preventive care – it's being able to predict who's at risk and targeting them for certain preventive care measures.
What's your best advice for bringing up these conversations at holiday gatherings?
People like to talk about themselves, right? So just asking questions. You know: "Mom, grandma, what were things like when you were little? Was your mom taking care of somebody at home? Did you ever have to go to the hospital to visit so and so? Or, what happened when grandma was about to die – was she at home or the hospital?" That can give you a lot of information.