Misdirected efforts aren’t making Americans any healthier
By Philip Caper, M.D.
Bangor Daily News, Jan. 18, 2013
We Americans seem to be obsessed with our health. You cannot watch TV, read a magazine or surf the Web without being inundated with articles and ads touting some new way get healthier. As one result, we spend about double what other countries do on health care for our people. But are many of those resources being misdirected?
A report released recently by the Institute of Medicine and the National Research Council suggests they are. Their report documents the fact that, despite our high health care spending, Americans persistently die younger and live in poorer health than residents of most other wealthy countries. The life expectancy of Americans is now near the bottom among all developed countries.
A report released last September — that I discussed in an earlier column — estimated that about 30 percent of what we as a nation spend on health care is spent on things that have little or no effect on curing illness or on improving our health — in other words, wasted. But even that which is spent effectively for medical care is directed mostly at fixing something that is already broken — a patient with a heart attack, for example — rather than preventing the illness in the first place. While we are able to cure infections, control hypertension or diabetes and treat or replace worn out joints, we are much less effective at preventing such illnesses.
It is becoming increasingly clear that many modern-day causes of disease, disability and mortality have their roots in what are known as “the social determinants of health.”
The IOM-NRC report pointed out that car accidents, gun violence and drug overdoses are major contributors to reduced life expectancy for Americans under age 50, as were high rates of heart attacks, lung disease and diabetes. Why, as a nation, are we so sick?
Some answers to that question can be found in a recent book, “The Spirit Level,” by British epidemiologists Kate Pickett and Richard Wilkinson. In it, they suggest an even more basic cause of our dismal national performance: extreme inequality of income, where the U.S. tops the list of wealthy countries. We are suffering from excessive accumulation of wealth at the top, growing poverty at the bottom, and a hollowing-out of the middle class.
Based on data from 23 rich countries and all 50 U.S. states, they compare the prevalence of nine types of physical and social pathology with the level of income inequality among each state in the U.S. and in each country. The U.S. is ranked at or near the top for income inequality among wealthy countries.
High levels of income inequality are associated with high rates of obesity, teenage pregnancy, violence, incarceration, mental health problems, drug abuse, school dropout rates, poor community life and social relations, poor physical health and low life expectancies. Among eight wealthy countries studied, the U.S. had the highest income inequality and lowest social mobility leading to the least opportunity for career and income advancement.
Wilkinson and Pickett have documented that in societies with high levels of inequality, many people suffer from low levels of self-esteem, high levels of insecurity and feelings of low status. These combine to produce high levels of chronic anxiety, which is thought to an important factor in causing cardiovascular disease (such as high blood pressure and heart attacks), and is known to stimulate the production of abnormally high levels of adrenal steroids which are a risk factor for diabetes with all of its consequences.
I’m all in favor of preventing illness as one way of lowering costs. These studies seem to indicate that a lot of factors other than medical care are important in doing so. Our high levels of social and physical pathology may be just the symptoms, not the underlying causes of our dismal performance.
There are a number of ways to reduce income inequality. Tax and social welfare policies are among them. In Maine and throughout the country we are now having a vigorous national debate about both.
American health care is far too wasteful and expensive. At almost 18 percent of our gross domestic product, it has to be a major contributor to our high and rising income inequality by shifting wealth from those who use health care products and services to those who provide them. Our health care system may be approaching the point where it is now doing more harm than good.
The bottom line of these findings seems to be that in nations with progressive taxes and a robust social safety net, that includes an efficient universal health care system, everybody is better off — including the very rich.
It seems to me that’s something worth thinking about as we continue our debate about national priorities.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at firstname.lastname@example.org.