Mares: Health Care

Feb 5, 2013

According to a recent study by the National Research council and Institute of Medicine, across most health indicators, age and wealth groups, people in the US have shorter lives and more illness than people in other advanced countries. Even advantaged Americans - with health insurance, college educations, higher incomes, and healthier behaviors -appear to be sicker than their peers in other rich nations.

Among these countries, the U.S. is at or near the bottom in nine key areas of health. These are infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.

There appear to be a number of reasons for this, but perhaps chief among them is our flawed health care system - one that leaves a relatively large uninsured population with little or no access to primary care. Plus, the US has a higher poverty rate, poorer general education system, and poorer social safety net - while at the same time, Americans practice unhealthy behaviors, from over-eating to drug abuse. The physical environment dominated by the automobile discourages physical activity and encourages obesity, not to mention increases in injury and death when driving and alcohol mix. The study also found that Americans are more likely to use fire arms in acts of violence. Our rate of homicide by firearms is 20 times higher than in the other countries of the study.

To get a local perspective, I went to my Tuesday morning walking buddy, pediatrician Joe Hagan, who's been thinking about youth health for his entire career. Among other things, Joe was an editor of The Bright Futures Guidelines, the national standard for preventive health care for children, incorporated by the affordable care act.

Then,one morning as we walked along the Lake with temperatures huddled around zero, Joe told me about a developing concept of health care, called life course, based on research documenting the important role early life events play in shaping an individual's health trajectory. The interplay of many risk and protective factors, such as socioeconomic status, toxic environmental exposures, health behaviors, stress, and nutrition, influence health throughout one's lifetime.

Joe says that prevention is ...about promoting health; it's not just about detecting disease. Promoting health means promoting healthy families, both physically and emotionally. Preventing hunger, substance use and family violence is promoting health. Promoting mental health of parents promotes the health of children, he concluded.

It reminded me of one of the points President Obama made in his recent Inaugural Address, when he said that our commitments to each other through Medicare, Medicaid and Social Security, ...do not sap our initiative, they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.

We may never be #1 in national health and health care, but surely we can do better than 17th.