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Health Care in the U.S. and the World Martin Donohoe Determinants of Health Era Socioeconomic status Sex Race Location Environment Genetics Health Habits Access to Care Health Care Prevention Diagnosis Treatment The State of U.S. Health Care 45 million uninsured

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Health care in the u s and the world l.jpg

Health Care in the U.S. and the World

Martin Donohoe


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Determinants of Health

  • Era

  • Socioeconomic status

  • Sex

  • Race

  • Location

  • Environment

  • Genetics

  • Health Habits

  • Access to Care


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Health Care

  • Prevention

  • Diagnosis

  • Treatment


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The State of U.S. Health Care

  • 45 million uninsured

    • 45,000 deaths/year due

  • Millions more underinsured

    • Remain in dead-end jobs

    • Go without needed care and/or prescriptions

    • Marry


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The State of U.S. Health Care

  • US ranks near the bottom among westernized nations in overall population health (#24), life expectancy (#42), infant and maternal mortality, etc.

  • 20-25% of US children live in poverty


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Health Care Expenditures per Capita

  • U.S. = $8,160

  • Canada, Australia, Japan, Europe: $3,000 to $6,000

  • Typical poor African/Asian country = $5-$50


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Who Pays for Health Care?

  • Government (federal, state, and local)

    • Medicare, Medicaid, VA, IHS, jails and prisons

  • Private insurance

    • Primarily employer-based

  • Out-of-pocket


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Health Insurance Industry

  • Delisting

  • Cherry picking

  • Pre-existing conditions

  • High administrative costs

    • 15-30% (vs. 2-3% for Medicare and Medicaid)

  • Large profit margins

  • Loyalty: shareholders (not patients)

  • Corruption


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Distribution of National Health Expenditures


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Some Reasons for Rising Health Care Costs

  • Aging population

    • Chronic diseases

  • Technological advances

  • Exploding drug costs

  • Procedural variability

  • Administrative costs


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Drug Companies’ Profits

(“Drug companies prices barely cover R &D costs and risks.”)

3rd rank

Fortune Magazine


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Drug Companies’ Cost Structure


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Innovation:Published Research Leading to Drugs


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Lobbying

  • 15,000 full-time lobbyists

  • Health insurance, pharmaceutical, and organized medicine spend huge sums of money to influence legislation and policy


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The “Global Economy”

  • 53 of the world’s 100 largest economies are private corporations; 47 are countries

    • Wal-Mart is larger than Israel and Greece

    • AT&T is larger than Malaysia and Ireland


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Major Contributors to Illness and Death

  • 40% of US mortality due to tobacco, poor diet, physical inactivity, and misuse of alcohol

  • Every $1 invested in programs covering above items saves $5.60 in health care costs


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Poverty and Hunger

  • US: 13% of residents and 18% of children live in poverty

  • Rates of poverty in Blacks and Hispanics = 2X Whites

  • Poverty associated with worse physical and mental health


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Economic Disparities

  • Women 60ȼ/$1 Men

  • Median income of black U.S. families as a percent of white U.S. families approximately 60% (no change since late 1960s)


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Racial Disparities in Health Care:African-Americans

  • Higher maternal and infant mortality

  • Higher death rates for most diseases

  • Shorter life expectancies

  • Less health insurance

  • Undergo fewer diagnostic tests / therapeutic procedures


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Racial Disparities in Health Care:African-Americans

  • Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000

    • Medical advances averted 176,633 deaths


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Outside the US

  • One billion people lack clean drinking water and 3 billion lack sanitation

    • 13,000-15,000 deaths per day worldwide from water-related diseases

  • Hunger kills as many individuals in two days as died during the atomic bombing of Hiroshima


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Water

  • Amount of money needed each year (in addition to current expenditures) to provide water and sanitation for all people in developing nations = $9 billion

  • Amount of money spent annually on cosmetics in the U.S. = $8 billion


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Human Poverty


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Percentage of population living on less than one dollar per day


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HIV Prevalence


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Malaria Deaths


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Overpopulation

  • World population - exponential growth

  • 1 billion in 1800

  • 2.5 billion in 1950

  • 6 billion in 2000

  • 6.8 billion in 2009

  • est. 8-10 billion by 2050


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Status of Women

  • Women do 67% of the world’s work

  • Receive 10% of global income

  • Own 1% of all property


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Worldwide, every minute

  • 380 women become pregnant (190 unplanned or unwanted)

  • 110 women experience pregnancy-related complications

  • 40 women have unsafe abortions

  • 1 woman dies from childbirth or unsafe abortion

  • Reason: Lack of access to reproductive health services


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Deaths in War

  • 18th Century = 19/million population

  • 19th Century = 11/million population

  • 20th Century = 183/million population

  • Civilian Casualties:

    • 10% late 19th Century

    • 85-90% in 20th Century


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Contemporary Wars

  • 250 wars in the 20th Century

  • Most conflicts within poor states

    • Many over oil


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War Deaths, 1945-2000


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Inverse Care Law

Those countries that need the most health care resources are getting the least


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The Medical Brain Drain

Five times as many migrating doctors flow from developing to developed nations than in the opposite direction


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Tobacco

  • Cigarettes most heavily marketed products in the world

    • $2 billion/year in the U.S.

    • U.S. leading exporter of cigarettes


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Consequences of Environmental Destruction

  • Global warming: 160,000 deaths and 5.5 million disability-adjusted life years lost per year (will double by 2020)

  • Air pollution: 60,000 - 75,000 premature deaths/yr. (U.S.); 1.8 million worldwide


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Consequences of Environmental Destruction

  • Pesticides in food → 1,000,000 deaths over the last 6 years; 1 million cancers in current generation of Americans

  • Lead and mercury exposure multi-billion dollar problems

  • Other toxins – linked with heart disease, asthma, cancer, infertility, Parkinson’s disease, Alzheimer’s, autism, etc.


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Toxic Pollutants

  • ¼ US citizens live within 4 miles of a Superfund site

  • Environmental Racism

    • Waste dumps/incinerators more common in lower SES neighborhoods

    • e.g., “Cancer Belt” (Baton Rogue to New Orleans)


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Extinction/Species Loss

  • Mass Extinction

  • More than 1/2 of the top 150 prescription drugs from plants, other living organisms

  • More than 250,000 known flowering species

    • <0.5% surveyed for medicinal value


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Overconsumption (“Affluenza”)

  • U.S. = 6.3% of world’s population

    • Owns 50% of the world’s wealth

  • U.S. responsible for:

    • 25% of world’s energy consumption

    • 33% of paper use

    • 72% of hazardous waste production


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New Remote Control Can Be Operated by Remote: No More Leaning Forward To Get Remote From Coffee Table Means Greater Convenience For TV Viewers


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But Are We Happier?

  • Average American works 200 more hrs/yr than in 1960 (#1 in world)

  • Vacations shorter

  • 8/10 Americans want a new job

  • Fewer close friends

  • More loneliness/depression

  • Pharmaceutical fixes


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Worldwide Health: Can Aid Help?

  • US ranks 21st in the world in foreign aid as a percentage of GDP (0.7%)

  • Foreign Aid:

    • 1/3 military

    • 1/3 economic

    • 1/3 food and development


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Worldwide Health: Can Aid Help?

  • U.S charitable giving approximately $250 billion/year

    • 2.5% of income

    • 2.9% at height of Great Depression

    • Poor donate higher percentage of their incomes than rich; blacks more than whites

    • Most stays in US


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US Charity Care Suffering

  • Public hospitals and ERs closing

  • Hospitals turning to lucrative initiatives to improve financial situation

    • Cosmetic surgery, luxury clinics, aggressive billing practices (including charging uninsured more than insured), recruiting wealthy foreign patients


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Maldistribution of Wealth

  • Top 250 billionaires worldwide worth $1 trillion, the combined income of bottom 2.5 billion people (45% of world’s population)

  • U.S: Richest 1% of the population owns 50% of the country’s wealth -poorest 90% own 30%-widest gap of any industrialized nation


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Income Inequality Kills

Higher income inequality is associated with increased mortality at all per capita income levels


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Maldistribution of Wealth

  • In countries with moderate levels of wealth, happiness is highest where income inequalities lowest

    • Major league baseball teams are more successful when players’ salaries are more equitably distributed


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Maldistribution of wealth

Less than 4% of the combined wealth of the 225 richest individuals in the world would pay for ongoing access to basic education, health care (including reproductive health care), adequate food, safe water, and adequate sanitation for all humans


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Health Requires Equality

  • “All men are created equal”

    • Declaration of Independence

  • “Some people are more equal than others”

    • George Orwell


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Hudson River, 2009


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U.N. Declaration of Human Rights

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care”


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Solutions

  • Pay as you go

  • Insurance

  • Government-run program

    • VA, IHS

  • Current Congressional Proposals


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  • "If anyone...has a better approach that will bring down premiums, bringdown the deficit, cover the uninsured, strengthen Medicare for seniors,and stop insurance company abuses, let me know."-- President Obama, State of the Union, 1/27/10


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Single Payer

  • Cradle to grave, portable insurance for everyone

  • All medically-necessary services covered

  • Free choice of doctor and hospital

  • Global and local budgeting determined by physicians, patients, other health professionals

  • Cost saving

  • Broad support


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Single Payer

  • Not socialism any more than having a police force and fire department which serve everyone or offering free public education to children through grade twelve is socialism

    • Imagine if insurance companies ran the fire department


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What You Can Do

  • Educate yourselves and others

    • “Information is the currency of democracy” (Thomas Jefferson)

  • Take care of your body – you only get one (no trade-ins)

  • Live, laugh, and love – life is short

  • Join groups working to improve health care


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Act Now!

"If you think you are too small to have an impact, try going to bed with a mosquito in your tent“

- Anita Roddick


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Further Info/References

Public Health and Social Justice Website

http://www.phsj.org

Physicians for a National Health Plan

http://www.pnhp.org/

Kaiser Family Foundation

http://www.kff.org/

Martin Donohoe

martindonohoe@phsj.org


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