The Really Big Picture

The graphic below caught my eye in yesterday's New York Times and it haunted me. It shows the rankings for infant mortality rates in the US and other countries in 1960 and 2004.

It's a sad reminder of the deterioration of public health in one of the richest countries on earth and the country that spends more on health care than any other in the world. It must be at least partially explained by the fact that health care in this country remains a commodity rather than a basic human right.

You might be wondering why this is appearing on a blog devoted to exploring controversial issues in preventing infections in hospitals. As a hospital epidemiologist in a safety net hospital, I have always struggled with this big issue of distributive justice: as we continously pour more energy and resources into perfecting inpatient medical care, more of our people are losing access to care. Unfortunately, our public health metrics reflect this abysmal reality. As a society we have decided that it's more important to provide perfect inpatient medical care to a stroke patient than to ensure access to basic primary care and treatment of her hypertension that would have averted the stroke, a paradox that I will never understand.

Wouldn't it be refreshing if a JCAHO surveyor asked what your hospital is doing to care for the uninsured? In my wildest dreams, there's a National Patient Safety Goal that addresses how well a hospital provides evidence-based primary care to medically indigent patients. Maybe someday. For now, JCAHO has its hands full trying to eliminate unapproved abbreviations.