Posts Tagged ‘Health Care’
April 7 is World Health Day, an annual event sponsored by the World Health Organization (WHO) to promote greater awareness of global health issues. Conferences and activities all over the world address diverse topics like life expectancy, infant mortality, spread of diseases, access to clean drinking water, healthcare infrastructure, to mention a few. This year’s main focus is on the growing threat of foodborne illnesses.
Life expectancy, in particular, has long been considered a leading indicator for progress or decline of public health, and many changes have taken place in this regard over time. However, the gap between the richest and poorest parts of the world in terms of health status and longevity remains wide and may not significantly narrow in the foreseeable future. For example, most African populations still fall many years short behind their European and North American counterparts.
An outlier turns out to be Qatar, which is now rated the healthiest country in the world, followed by Norway and Switzerland. Why Qatar? Although this relatively small country with a population of just over 2 million has no national healthcare system, easy and affordable access to medical services seems one of the distinguishing factors. With more than three physicians per 1,000 people, the country is better staffed with healthcare professionals than most others. By comparison, the United States has less than two and a half doctors per 1000 inhabitants, while Canada has about two.
Yet, the US is well known for having the highest medical expenditures in the world. According to Forbes, the annual per capita spending on healthcare here is well over $8,000. Canada spends a bit more than half as much.
What do Americans get in return for that kind of money? Unfortunately, a lot less than one would expect. Among 10 of the most developed countries, the US comes in dead last, behind Canada, Australia, New Zealand, and most European nations.
The most striking deficiencies are related to a convoluted healthcare system that is less efficient and less affordable for large parts of the population.
Inequality is a particularly pressing problem. According to the report on healthcare spending and based on data by the WHO, the US ranks clearly last on measures of equal access to healthcare.
“Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one third or more lower-income adults in the US said they went without needed care because of costs,” it said in the report.
By contrast, Canada was generally lauded for its universal healthcare system but also faulted for its high costs as well as timeliness and efficiency of care. High marks were given to Australia for quality and cost efficiency.
To turn things around, WHO experts recommend that policymakers in the respective healthcare systems combat first today’s fastest spreading health threats like lifestyle-related chronic diseases, a.k.a. non-communicable diseases (NCDs), including cancer, heart disease, and lung disease, largely through preventive measures like reducing tobacco use and dietary improvements.
Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com. For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).
It shouldn’t come as a big surprise. On average, Americans are in poorer health and have shorter lifespans than the citizens of other affluent countries, including most Western European nations, Australia, Canada and Japan. Considering that close to 50 million people, almost 20 percent of the population, are without health insurance and many more with only limited access to medical services, a decline in public health would seem inevitable. Still, the findings of a recent study by the U.S. government are quite shocking.
According to the Institute of Medicine (IOM), America currently ranks at or near the bottom among the 17 richest nations in the world in terms of life expectancy and chronic diseases like heart disease, lung disease, obesity and diabetes as well as injuries and death from violence and sexually transmitted diseases.
What’s even more disturbing is that these statistics not only apply to the poor and the elderly, as experts long expected, but across all demographics, including young adults and those who can afford health care coverage.
“We are struck by the gravity of these findings,” said Dr. Steven Woolf, professor of medicine at Virginia Commonwealth University and chairman of an expert panel that was tasked with the study. “What concerns [us] is why, for decades, we have been slipping behind.”
Even first generation immigrants coming to the U.S. show negative health effects within a relatively short time due to diet and lifestyle changes. According to the National Institute of Health (NIH), obesity rates among immigrants roughly equal those of U.S.-born adults within 10 to 15 years after taking up residence here. One study found that migrants from comparatively poor countries like Mexico or Guatemala are especially prone to develop diseases like obesity, diabetes and heart problems because of dietary changes.
“If you go with the flow in America today, you will end up overweight or obese, as two-thirds of all adults do,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC) in an interview with USA TODAY. “Obesity is one of the few things that has gotten worse quickly. It really is a very serious health problem,” he added.
The obesity epidemic is also one of the main reasons why it is so hard to get health care costs under control in this country. It costs $1,400 more per year to treat an obese patient compared to someone who is normal-weight and $6,600 more to treat a diabetic, said Dr. Frieden.
What changed in the U.S. more profoundly than in other countries – although similar trends are now emerging worldwide – is a dramatic shift in our eating habits. We eat more conveniently prepared but highly processed foods and enjoy fewer healthy meals made from scratch. Our portion sizes have gone through the roof. We also have become more sedentary due to progressive automation in the workplace, longer commutes and lack of safe outlets for physical activity.
“What has happened is that the structure of our society has changed in ways that make it difficult to maintain a healthy weight,” said Dr. Frieden. It’s a fertile ground for the diseases we now see on an epidemic scale.
Obviously, there is not one solution that could undo all of these regrettable developments. Multiple measures will have to be put in place and made to work together. Personal responsibility is certainly part of the equation, but so are numerous other components such as better health and nutrition education for the public, further improvements to school lunch programs, reintroduction of mandatory physical education (PE), more effective safety and disclosure regulations of agricultural and food manufacturing industries, to name just a few.
The current deterioration of our public health is not irreversible. On the contrary. Most of our ailments are self-inflicted and therefore in our control if we only muster the will to address them in meaningful ways.
Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.”, and at amazon.com. You can follow Timi on Twitter and on Facebook.
Even people who decry European social policies as socialism or welfarism admit that countries like Sweden, France or Germany provide their citizens with benefits not commonly available in the United States in terms of access to health care, job security, unemployment aid, maternity leave, child day care, paid vacations and more.
While it is true that the U.S. spends more than most countries on health care, the average life expectancy is lower and infant mortality is higher here than in many other industrialized nations. Why the discrepancy?
Based on a study that compared the various health care policies of the 30 most developed countries in the world, researchers found that spending on health care combined with spending on social services made the most significant difference. The study report, which was published in the journal BMJ Quality and Safety, concluded that spending on social services can extend and improve people’s lives in ways that health care alone cannot achieve.
“We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money – far from it,” wrote Elizabeth H. Bradley, a professor for public health at Yale University, and Lauren Taylor, a program manager at Yale’s Global Health Leadership Institute, in a co-authored op-ed article in the New York Times (12/9/2011).
“America is one of only three industrialized countries to spend the majority of its health and social service budget on health care itself. For every dollar we spend on health care, we spend an additional 90 cents on social services. In our peer countries [mostly in Europe], for every dollar spent on health care, an additional $2 is spent on social services. So not only are we spending less, we’re allocating our resources disproportionately on health care,” they added.
Health experts agree that unmet social needs often lead to an increase in acute health problems. Like actual diseases, lack of health insurance, job insecurity and poverty contribute heavily to the worsening of our public health. For millions of Americans, the hospital emergency room is the only option left in an otherwise broken system, a last resort that is not really sustainable.
“It’s time to think more broadly about where to find leverage for achieving a healthier society,” wrote Bradley and Taylor. The simplest way would be to invest more in social services, like the Europeans do. But this would mean an extended role of government and probably higher taxes, both of which are considered non-starters in the current political climate.
Still, the authors insist that introducing variations of the European model may be possible at some point in the future. As an example where this is already happening they cite a program called “Stand Downs” by the Department of Veterans Affairs, which addresses a number of social needs of retired service members as part of their health care plan.
So, what can be done in the meantime for the rest of us? For once, we need a better understanding of the importance of pro-active instead of strictly re-active health care. While it is common knowledge that “an ounce of prevention is worth a pound of cure,” we have yet to turn these insights into action. Health education and counseling should be considered as important as drug prescriptions and surgery – and appropriately funded. The fact that many of today’s common diseases are caused by poor lifestyle choices, bad eating habits, stress and sleep disorders should make us rethink our health care priorities.
Furthermore, studies have shown how access to basic health care can give people peace of mind and improve their overall well-being and quality of life (as I have reported earlier in an article titled “Health Insurance Shown to Make a Big Difference in Quality of Life”). It is part of a safety net nobody should have to be without. Seeing so many people in our midst deprived of some of the most elementary social services is intolerable. We can and must do better.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.
The number of Americans living below the official poverty line has increased to 46.2 million, according to just released statistics by the Census Bureau. It is a record in the 52 years the bureau has surveyed poverty in the United States.
The median household income fell nationally last year back to the levels of 1997. It is the first time since the Great Depression that Americans earned less, adjusted for inflation, than they did over a decade ago.
Predictably, minorities were hit the hardest, with poverty rates twice as high as those of non-Hispanic whites. Southern states had the highest amount of people falling into poverty – almost double the rate of the Northeast, Midwest and West.
The poverty threshold is an annual income of $22,314 for a family of four and $11,344 for a single person.
“This is truly a lost decade,” said Lawrence Katz, an economics professor at Harvard University. “We think of America as a place where every generation is doing better, but we’re looking at a period when the median family is in worse shape than it was in the late 1990s.”
As income declined, the number of people without health insurance coverage rose. Nearly 50 million are now uninsured, almost a million more since 2009. For many working-age Americans, job loss and long-term unemployment lead to loss of employer-provided health insurance or affordable alternatives. And those who are working often struggle to maintain their coverage. In 2010, approximately 55 percent of working Americans were insured by their employers, a 10 percent decrease from 2000, according to the census report.
Studies on the causes of poverty have shown that there are three important components that hold together the social safety net for most people: Income, health and relationships. If one of these fails, the other two are usually still able to bridge the gap, at least for some time. However, if two out of three are diminished, the chances for falling into poverty and even homelessness rise sharply. In other words, if you lose your job but are healthy and have a stable marriage or partnership (especially if there is a second income in a household), you are much better equipped to get through the ordeal of temporary unemployment than if you are sick and/or on your own. That may sound like a no-brainer, but it is exactly the kind of situation that most poor people are dealing with.
The harsh realities of poverty affect the youngest members of society even more. 22 percent of children and adolescents under 18 are now considered poor. Hunger or what is called in bureaucratic terms, “food insecurity,” affects 15 million kids in this country today. Considering the importance of healthy nutrition for normal physical and mental development at a young age, there is a whole generation that is being lost in front of our eyes.
Nutrition-related diseases, such as obesity, diabetes and high blood pressure, are most common among the poor. With healthy foods out of reach because of high prices and lack of outlets in low-income neighborhoods, poor families have little choice but to survive on junk food.
The New York City Department of Health and Mental Hygiene has recently published a report on “Health Disparities in Life Expectancy and Death,” documenting current health disparities in New York City based on differences in race, ethnicity and economics. Other factors included in the study were social and physical environmental conditions, opportunities, stressors that impact health, access to primary and preventive health care and quality of health care received.
Trying to identify how poverty and health are interrelated, the researchers wrote: “Living in poverty makes it difficult to know about, find or access a variety of resources that promote health and prevent illness. For example, people living in poor neighborhoods may have access to fewer opportunities to exercise and buy healthy food. Living with limited resources also increases stress and anxiety, which can, in turn, lead to unhealthy habits, like smoking and drug use. In the other direction, poor health can prevent people from completing their education and obtaining well-paying jobs, which can lead to subsequent poverty.”
In other words, the decline of income, social safety and health are all part of the same vicious cycle. To break it, the Health Department makes a number of recommendations, including setting up “health policies that benefit vulnerable populations,” directing “resources to target communities disproportionately affected by illness and premature death,” and implementing “policies that reduce economic and social disadvantages.”
In the meantime, the White House and Congress continue debating how to cut hundreds of billions of dollars more from entitlements and aid programs. I guess the statistics are not scary enough just yet.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” ( http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.