On Preventable Death

public health

A new study released in Health Affairs found that out of nineteen industrialized nations, the U.S. ranked dead last in preventable deaths. Here is the Abstract:

We compared trends in deaths considered amenable to health care before age seventy-five between 1997–98 and 2002–03 in the United States and in eighteen other industrialized countries. Such deaths account, on average, for 23 percent of total mortality under age seventy-five among males and 32 percent among females. The decline in amenable mortality in all countries averaged 16 percent over this period. The United States was an outlier, with a decline of only 4 percent. If the United States could reduce amenable mortality to the average rate achieved in the three top-performing countries, there would have been 101,000 fewer deaths per year by the end of the study period.

While the reasons for the U.S. performance are many, IMO one of the primary factors is that the U.S. does not allocate adequate resources to preventive medicine and public health. We have noted before on this blog the 2006 statistics that 96% of U.S. health care dollars are spent on acute care and biomedical research, with only 1-2% expended on preventive medicine and public health. Almost by definition, acute care does little to prevent morbidities that over time are productive of higher mortality.

This study adds to the copious data finding that the U.S. health care system is mediocre at best as compared to other industrialized nations. Some of this data is methodologically flawed, but there remains ample evidence to conclude that as to overall population health, the U.S. has much room for improvement. And a significant portion of the improvement, IMO, ought to come in increased resources and attention paid to preventive medicine and public health, since there is excellent evidence that such interventions are likely to have a much greater effect on population health than acute care interventions.

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Article on the Law and the Childhood Obesity Epidemic

Childhood Obesity Epidemic

Jess Alderman, Jason A. Smith, Ellen J. Fried, and Richard A. Daynard have uploaded to SSRN their article entitled “Application of the Law to the Childhood Obesity Epidemic,” Journal of Law, Medicine and Ethics, 35 (2007): 90-112. The Abstract:

Childhood obesity is in important respects a result of legal policies that influence both dietary intake and physical activity. The law must shift focus away from individual risk factors alone and seek instead to promote situational and environmental influences that create an atmosphere conducive to health. To attain this goal, advocates should embrace a population-wide model of public health, and policymakers must critically examine the fashionable rhetoric of consumer choice.

I have not made it through the entire article, but the first half of it is outstanding, touching on a number of themes. One of the most interesting narratives in the history of medicine is the role of the therapeutic revolution on health. That is, many people ascribe to the vision of Jonas Salk, intrepid investigator, finding a vaccine for polio and saving lives. Of course, practice and translational research did and continues to save lives. But it is generally thought that the largest factors in the dramatic reduction in mortality at the fin-de-siecle in the U.S. relate to the newly-born field of public health (but cf. Epstein and Gostin’s critique). Public health was successful in part because its progenitors ascribed to conceptions of illness that revolved around notions of filth and hygiene. The public health campaigns of the late 19th-early 20th century have to be conceptually located in context of the culture that would have undertaken them.

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