Search This Blog

10 October 2008

Thinking Differently About Health Care

The American health care system is on life-support. Priced at nearly $8,000 a year per American, and soon to be 20 percent of the GDP, it’s more expensive by 40-60 percent than health care systems in any other industrial country, and totals nearly half the health care budget of the entire world. Yet it leaves 48 million Americans uncovered by health insurance and produces remarkably poor results.

According to the fascinating article linked below, it might help to consider American health as a house. Health care is the -- very expensive -- roof, the final protection against illness. In some ways it’s a preventive system, but mostly it’s sickness care.

In most other countries, the roof is a simpler affair. These health care systems rely much more on prevention. Yet the people in those “houses” live longer, healthier lives. That’s because in those other countries, the foundation and the walls of the house are stronger, with fewer cracks to let in the cold.

Start with the foundation. That’s the head start toward health that children in most other rich countries receive. In part because of better pre-natal care, infant mortality in all other industrial countries is lower than in the United States, which ranks 42nd in the world.

In every country in the world except the United States, Liberia, Swaziland and Papua New Guinea, mothers, and often, fathers, are guaranteed paid time off from work to take care of newborns. In many cases, such “family leave” extends for up to a year or more.

The first wall is lifestyle. Our tax system subsidizes producers of sugars and fats and our marketing system relentlessly advertises unhealthy foods. At the same time, Americans tend to work longer hours than people in other rich countries.

Wall number two is stress relief. It’s no secret in the field of public health that stress is a killer. Several factors make American life particularly stressful. Stress can result from insecurity. As the American social safety net has been gutted in recent years and job protections have been reduced, life in America is far more insecure than in other rich countries. Stress is also the result of time pressures and overwork. Breaks from a stressful workplace are seen by Europeans as yet another way to improve health.

The third wall is social connection. It’s a given in the field of public health that social connection strengthens immune systems and improves physical well-being. Yet America is an increasingly lonely country. More and more people, and especially older Americans, live alone, far more than in other rich countries. A recent study found that the average American has only two close friends he or she can turn to. A quarter have none at all.

The fourth wall is a safe environment. Americans rank at the bottom in child safety, with the highest rates of accidents among children. Partly, time pressure on American parents leave them less able to supervise their children. Other studies show extremely high rates of accidents in the workplace compared to other nations. Finally, and this is no small matter, every other industrial country guarantees its workers paid time off from work when they are sick; only the U.S. does not. Those countries know that without paid time off, workers will come to work sick, and will get others sick and stay sick longer.

To achieve better health outcomes, Americans must begin to see health as a holistic matter. Right now the American health care “house” has a foundation that is part marble, part rotting wood and part dirt. It has four walls that are a mixture of teak, balsa wood and bamboo, all of them in sorry shape. And finally, it has a gilded roof with millions of holes.


* World Changing October 2, 2008

No comments: