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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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determinants of health
Determinants of Health
  • Era
  • Socioeconomic status
  • Sex
  • Race
  • Location
  • Environment
  • Genetics
  • Health Habits
  • Access to Care
health care
Health Care
  • Prevention
  • Diagnosis
  • Treatment
the state of u s health care
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
the state of u s health care8
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
health care expenditures per capita
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
who pays for health care
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
health insurance industry
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
some reasons for rising health care costs
Some Reasons for Rising Health Care Costs
  • Aging population
    • Chronic diseases
  • Technological advances
  • Exploding drug costs
  • Procedural variability
  • Administrative costs

Drug Companies’ Profits

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

3rd rank

Fortune Magazine

  • 15,000 full-time lobbyists
  • Health insurance, pharmaceutical, and organized medicine spend huge sums of money to influence legislation and policy
the global economy
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
major contributors to illness and death
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
poverty and hunger
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
economic disparities
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)
racial disparities in health care african americans
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
racial disparities in health care african americans35
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
outside the us
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
  • 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
  • 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
status of women
Status of Women
  • Women do 67% of the world’s work
  • Receive 10% of global income
  • Own 1% of all property
worldwide every minute
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
deaths in war
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
contemporary wars
Contemporary Wars
  • 250 wars in the 20th Century
  • Most conflicts within poor states
    • Many over oil
inverse care law
Inverse Care Law

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

the medical brain drain
The Medical Brain Drain

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

  • Cigarettes most heavily marketed products in the world
    • $2 billion/year in the U.S.
    • U.S. leading exporter of cigarettes
consequences of environmental destruction
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
consequences of environmental destruction52
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.
toxic pollutants
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)
extinction species loss
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
overconsumption affluenza
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

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

but are we happier
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
worldwide health can aid help
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
worldwide health can aid help59
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
us charity care suffering
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
maldistribution of wealth
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
income inequality kills
Income Inequality Kills

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

maldistribution of wealth63
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
maldistribution of wealth64
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

health requires equality
Health Requires Equality
  • “All men are created equal”
    • Declaration of Independence
  • “Some people are more equal than others”
    • George Orwell
u n declaration of human rights
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”

  • Pay as you go
  • Insurance
  • Government-run program
    • VA, IHS
  • Current Congressional Proposals

"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

single payer
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
single payer71
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
what you can do
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
act now
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

further info references
Further Info/References

Public Health and Social Justice Website

Physicians for a National Health Plan

Kaiser Family Foundation

Martin Donohoe