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.
Infant mortality and life expectancy are repeatedly cited as indicators of healthcare quality, but in reality these are very poor indicators that are subject to great statistical bias.
ReplyDeleteThe US counts every live birth regardless of life expectancy. Many socialized systems (Germany, Canada) do not count infants under 500 grams, or with a life expectancy < 1 day in their live birth statistics. US infant mortality is on par with Norway when adjusted for birth weight.
Another commonly cited, but fallacious statistic is our life expectancy. The CDC reports that > 75% of the 40,000 deaths/yr in the age group of 10-24 are the result of MVA's, suicide, homicides, and other traumatic injuries. These deaths decrease overall life expectancy, and are totally unrelated to access to healthcare. US affluence has led to an obesity epidemic, smoking, and lack of exercise, which all cause disease, and decrease life expectancy, but are not at all a reflection of the quality of healthcare in the US. This is a cultural issue, not a result of poor access to healthcare. When adjusted for fatal injuries, the US life expectancy is higher than nearly every other industrialized nation.
Socialized government run healthcare systems are abysmal when compared to the US in cancer survival rates. US survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology 2007. These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average, and the US.